Abstract

Introduction/Background: Complete resection of all visible disease remains the gold standard in the surgical management of advanced ovarian cancer. If this is not deemed possible in the upfront setting, then interval cytoreductive surgery (IDS) should be undertaken after 3-4-cycles of neoadjuvant chemotherapy (NACT). Some patients undergo delayed surgery after 6-cycles of NACT (DDS) due to persistence of unresectable disease on interval scanning or factors associated with patient fitness. Current evidence regarding the outcomes of DDS is limited and conflicting. This study aimed to review the short-term outcomes for patients undergoing DDS compared with IDS at a single UK Centre.

Methodology: A retrospective cohort study was conducted including patients with FIGO stage III–IV epithelial ovarian cancer treated between June 2023 and January 2025. Patients who received primary debulking were excluded. Data were extracted from electronic patient records. Primary outcome was the rate of complete cytoreduction. Secondary outcomes included surgical complexity, duration of surgery, and perioperative complications.

Results: Forty-two patients met inclusion criteria: 28 (66.7%) underwent IDS and 14 (33.3%) underwent DDS. Median age was 65 years, and 95% presented with FIGO stage IIIC–IV disease. There were 4 ‘open and close’ laparotomies in the DDS cohort, and 6 in the IDS cohort. Where cytoreductive surgery was attempted, complete cytoreduction was achieved in 100% in the DDS cohort compared with 86% in the IDS cohort. DDS was associated with longer mean operating time (313 vs. 267 minutes) and higher rates of bowel resection (28.6% vs. 3.6%). Despite greater mean surgical complexity in the DDS group (5.1 vs. 3.5), overall complication rates were low and comparable between cohorts. All patients received postoperative chemotherapy.

Conclusion: DDS may facilitate higher rates of complete cytoreduction without increasing perioperative morbidity. These findings suggest a potential role for DDS in selected patients with advanced disease; however, further studies are needed to determine whether DDS achieves comparable progression-free and overall survival outcomes to IDS.