“Pseudo Cytoreductive Surgery” in Ovarian Cancer: Disturbing Insights from Referral Patterns to a Leading Oncology Center in India

Introduction: The fundamental approach to managing advanced epithelial ovarian cancer (EOC) involves optimal cytoreductive surgery (CRS) coupled with platinum-based chemotherapy. Despite this, index surgeries often miss potential disease-harboring sites, resulting in incomplete or “pseudo-complete” cytoreduction and early pseudo-recurrences, essentially a residual disease. Materials and Methods: A prospective observational study was conducted at the Department of Surgical Oncology, AIIMS, New Delhi, India, from 2012 to 2022. This study included 250 patients with stages III–IV ovarian cancer who had undergone prior surgery at other centers and required additional cytoreductive surgery. The aim was to identify residual disease sites and correlate operative records from previously documented optimal CRS with intraoperative findings at our oncologic center. Results: The bladder peritoneum, porta hepatitis, retrohepatic peritoneum, lesser omentum, and retroperitoneum were the most prevalent sites of residual disease. Significant agreement (kappa coefficient 0.61–0.80) was observed between documented operative records from other centers and our intraoperative findings for procedures like hysterectomy, bilateral salpingo-oophorectomy, and infracolic omentectomy. Moderate agreement (0.41–0.60) was noted for subdiaphragmatic peritonectomy, pelvic nodal dissection, and bladder peritonectomy, with fair agreement (0.21–0.40) for supracolic omentectomy, pouch of Morrison peritonectomy, lesser omentum omentectomy, and para -aortic lymph node dissection. Achieving no gross residual disease required standard cytoreductive procedures in 56% of patients, radical resections in 17%, and ultraradical surgery in 27%. Conclusion: Patients with advanced EOC benefit from complete CRS involving more aggressive resections. Training for surgeons should emphasize avoiding “pseudo-cytoreduction” to enhance overall patient outcomes.