Which is the better surgical strategy for newly diagnosed epithelial ovarian cancer: primary or interval debulking?

Surgical debulking is a mainstay of therapy for epithelial ovarian cancer. The traditional timing of this surgery has been prior to chemotherapy, but this view has been challenged over the last decade. This review will focus on the recently completed phase III studies of surgical timing and discuss exceptions to the superior paradigm of neoadjuvant chemotherapy followed by interval debulking.

The two completed studies have shown that neoadjuvant chemotherapy followed by interval debulking is the superior strategy for stage IIIc and IV ovarian cancer compared to primary surgery followed by chemotherapy. Survival outcomes were the same, but the morbidity for the patient and cost to the system and patient were less with interval debulking. Exceptions to this sequence are potentially stage I or II patients and those stage III patients who can be optimally debulked so as to receive intraperitoneal chemotherapy.

Chemotherapy followed by interval debulking will result in fewer and simpler operations and lesser morbidity for the patients resulting in cost savings for the healthcare system and less inconvenience and toxicity for the patient with equivalent survival outcomes. As such it is the superior strategy.