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Updated: Mar 20, 2026
Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma
Published on: January 22, 2022
The optimal time for surgery in women with serous ovarian cancer
Jocelyn M Stewart1, Alicia A Tone1, Haiyan Jiang1
1From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
Background:
Advanced high-grade serous ovarian carcinoma (HGSC) is commonly treated with surgery and chemotherapy. We investigated the survival of patients treated with primary or interval surgery at different times following neoadjuvant chemotherapy. Their survival was compared with that of patients treated with primary cytoreductive surgery and adjuvant chemotherapy.
Methods:
Patients with stage III or IV HGSC were included in this retrospective cohort study. Clinical data were obtained from patient records. Patients were divided into 2 groups based on treatment with neoadjuvant chemotherapy and interval cytoreductive surgery (NAC) or with primary cytoreductive surgery and adjuvant chemotherapy (PCS). Study groups were stratified by several clinical variables.
Results:
We included 334 patients in our study: 156 in the NAC and 178 in the PCS groups. Survival of patients in the NAC group was independent of when they underwent interval cytoreductive surgery following initiation of neoadjuvant chemotherapy (p < 0.001). Optimal surgical cytoreduction had no impact on overall survival in the NAC group (p < 0.001). Optimal cytoreduction (p < 0.001) and platinum sensitivity (p < 0.001) were independent predictors of improved survival in the PCS but not in the NAC group. Patients in the NAC group had significantly worse overall survival than those in the PCS group (31.6 v. 61.3 mo, p < 0.001).
Conclusion:
Women with advanced HGSC who underwent PCS had better survival than those who underwent interval NAC, regardless of the number of cycles of neoadjuvant therapy. Optimal cytoreduction did not provide a survival advantage in the NAC group.
