Changes in the extensiveness of initial debulking surgery with increasing neoadjuvant chemotherapy use in advanced ovarian cancer: a nationwide population-based study

Objective: To evaluate changes in initial debulking surgery extensiveness among advanced ovarian cancer (OC) patients alongside increasing neoadjuvant chemotherapy (NACT) use.Methods: This retrospective cohort study analyzed patients with distant disease in the Surveillance, Epidemiology, and End Results summary stage who underwent initial debulking surgery between 2013 and 2019 using the Cancer Public Library Database in South Korea.We evaluated temporal trends in extensive surgery by surgical site and compared primary debulking surgery (PDS) versus interval debulking surgery (IDS) subgroups.Extensive surgery was defined as standard surgery plus ≥1 additional complex procedure(s) involving nongenital tract organs or extra-abdominal metastatic sites.Results: Among 5,500 patients, 23.6% received NACT.The IDS proportion increased during the study period (p for trend <0.01).The proportion of extensive surgery remained stable at 45.4%-49.2%(p for trend=0.54).Bowel surgery decreased from 73.5% to 65.2% (p for trend=0.02),whereas thoracic surgery increased from 31.8% to 44.2% (p for trend <0.01).Extensive surgery was more frequent in IDS versus PDS (p<0.01).In IDS compared to PDS, bowel surgery declined over time (p for trend=0.02)and was less frequent (59.6% vs. 74.4%,p<0.01), while thoracic (49.5% vs. 35.8%,p<0.01) and other extra-abdominal surgeries (5.0% vs. 2.9%, p<0.01) were more common.Conclusion: Increased NACT use was accompanied by constant overall extensive surgery, with greater bowel preservation and more frequent thoracic and other extra-abdominal surgeries in patients with advanced OC who underwent IDS.