Analysis of factors impacting operability in stage IV ovarian cancer: Rationale use of a triage system

Objectives.: Determine impact of tumor distribution and surgery on prognosis in patients with stage IV epithelial ovarian cancer (EOC). Methods.: Retrospective analysis of stage IV EOC patients undergoing primary surgery between 1994 and 1998. Simple statistics, univariate and multivariable analysis were performed. Results.: Forty-nine patients met the inclusion criteria and entered the study. Five-year overall survival (OS) was 18.2%. Residual disease (RD) and radical surgical procedures (RSP) independently predicted survival (p < 0.001). Optimal debulking rate (RD < 1 cm) was 49% and median survival for optimal patients was 3.2 years. A very high risk group of patients based on extent of peritoneal disease, parenchymal liver metastases and ASA could be identified in whom the rate of optimal debulking was less than 25% (median survival 1.4 years). No patients with multiple liver metastases were optimally cytoreduced and the median survival was 1 year. Conclusions.: Based on patient factors and extent of disease, a high risk group of patients can be identified with a poor prognosis and low probability of optimal debulking. It appears justified in these patients to first exclude those with unresectable pleural disease and then perform laparoscopic assessment to determine extent of disease to triage patients to alternative strategies such as neoadjuvant chemotherapy.