[Treatment of advanced ovarian cancer--is residual tumor diameter less than 2cm optimal?]

The present study investigates whether residuum < 2cm is suitable for "optimal" by analyzing the impact of the size of the residuum on survival. Among 151 patients with stage III or IV ovarian cancer, 77 deemed "resectable" received debulking at initial laparotomy and received postoperative chemotherapy (PO group). The remaining 74 deemed "unresectable" had an exploratory laparotomy followed by neoadjuvant (NA) chemotherapy and subsequently received debulking (NA group). In the PO group, there was a significant difference in survival between patients with primary residuum < 2cm and > or = 2cm, and between < 0.5cm and > or = 0.5cm, respectively. Moreover, significant difference in survival was observed among each group with no residuum, macroscopic residuum but < 0.5cm, and 0.5cm < or = residuum < 2cm. The same trend was observed in the NA group. Altogether, a significant difference in survival was observed between patients with residuum < 0.5cm and those with 0.5cm < or = residuum < 2.0cm. In the PO interestingly, debulking the tumor to residuum < 2 cm did not influence the survival if postoperative chemotherapy was not effective. Thus, primary debulking of tumor to residuum < 2cm was significant when postoperative chemotherapy was effective. However, when we evaluated the residuum as an independent prognostic factor, residuum < 2 cm was insufficient but in view of the results of this study, < 0.5cm was judged to be suitable.