Surgical quality and long-term outcomes in advanced ovarian cancer: a population based registry study from Hamburg, Germany 2014–2024

PURPOSE: To evaluate the association of surgical quality and survival in patients with advanced ovarian cancer in a real-world setting. METHODS: This population-based registry study analysed FIGO stage III/IV ovarian cancer patients in Hamburg, Germany (2014-2024). Patients were categorized by surgical outcome (no macroscopic residuals vs. macroscopic residuals). Kaplan-Meier functions and Cox proportional hazards models estimated associations with survival outcomes. RESULTS: The cohort comprised 576 patients (median age 65 years, median follow-up 57 months). No macroscopic residuals were achieved in 370 patients (64.2%). In multivariable analysis, no macroscopic residuals were associated with reduced mortality risk (HR 0.62, 95% CI: 0.42-0.90) and reduced progression risk (HR 0.68, 95% CI: 0.49-0.94). Advanced FIGO stage, poor performance status, and increasing age were independent predictors of worse outcomes. CONCLUSION: Achieving no macroscopic residuals remains a critical prognostic factor in advanced ovarian cancer. The rate of 64.2% demonstrates that optimal surgical outcomes are achievable in routine practice, though opportunities for improvement remain compared to specialized centres.