Interventional procedure overview of maximal effort cytoreductive surgery for advanced ovarian cancer

There are no randomised trials comparing standard surgery against more extensive surgery.

Studies that were done outside the UK may not be generalisable to patients who are treated for ovarian cancer in the UK.

There are 2 prospective studies primarily aimed at assessing quality of life after the procedure, both of which included data from the UK.

Complete cytoreduction is not always assessed accurately and the definition of optimal cytoreduction has changed over time.

Studies have different inclusion criteria and the extent of surgery is categorised in different ways.

Some patients had primary debulking surgery and others had interval or delayed debulking surgery after neoadjuvant chemotherapy.

Several studies compare outcomes before and after changes in surgical treatment were implemented.

One study used data from a randomised controlled trial that was designed to assess different chemotherapy regimens (Horowitz 2015). This study excluded patients with residual disease >1cm and only included patients who could be treated surgically.

Adjuvant treatments for ovarian cancer have changed over time and this is also likely to have an impact on survival (for example, the use of bevacizumab).

In 1 cohort study, 34% (322/978) of patients had intraperitoneal chemotherapy.

There are several studies from Sweden and there is likely to be some patient overlap.

A recent Cochrane systematic review was identified, which included 3 retrospective, non-randomised studies, all of which were published before 2013.