Abstract
Epithelial ovarian cancer (EOC) remains a significant challenge in gynecologic oncology. This study aimed to evaluate the outcomes of multivisceral resection in advanced EOC, focusing on the effect of surgical complexity on post-operative morbidity, time to adjuvant treatment, and overall survival. This single-arm study included 74 patients with advanced EOC who underwent multivisceral resection between January 2018 and December 2021 at the Regional Cancer Centre, Thiruvananthapuram. The study introduced a modified version of Aletti's Surgical Complexity Scoring system to classify surgeries as intermediate or high complexity. Post-operative morbidity was assessed using the Clavien-Dindo scoring system. Time to adjuvant treatment and overall survival were also analyzed. Of the 74 patients, 80% underwent intermediate complexity surgeries, while 20% had high complexity procedures. Major morbidity (Clavien-Dindo grades 3 and 4) occurred in 10.9% of patients, with no significant difference between intermediate and high complexity surgeries (p = 0.86). Adjuvant chemotherapy was initiated within 6 weeks for 89.2% of patients. The overall 12-month and 18-month survival probabilities were 94% and 85%, respectively. Complete cytoreduction (CC-0) was achieved in 93.3% of cases, with significantly lower mortality rates compared to non-CC-0 cases (18.8% vs. 60%). Multivisceral resection in advanced EOC demonstrates favorable outcomes with acceptable morbidity rates, regardless of surgical complexity. The high rate of complete cytoreduction and impressive survival probabilities underscore the potential benefits of aggressive surgical approaches in advanced EOC. Although the subset analysis favored primary cytoreduction, further research with larger sample sizes is needed to confirm these findings and explore the impact of primary versus interval debulking surgery on long-term outcomes.