Complex surgery is not an independent predictor of survival in patients with advanced epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC), according to a recent study published in the Journal of Clinical Oncology.

Researchers led by Neil Horowitz, MD, of Brigham and Women’s Hospital in Boston examined 2,655 patients with EOC or PPC who were enrolled in the Gynecologic Oncology Group 182 study. Using the Kaplan-Meier method as well as multivariable regression analysis, they looked for the effects of disease distribution and surgery complexity on progression-free survival (PFS) and overall survival (OS).

They found that patients with less than 1 cm of residual disease after surgical cytoreduction had worse prognosis than patients who underwent complete surgical resection.

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Patients with high preoperative disease burden had shorter PFS and OS than those with moderate or low disease scores.

Upon controlling for disease score, residual disease, age, performance status, and other factors, they found that complex surgery was not an independent predictor of either PFS or OS.

“Complex surgery does not seem to affect survival when accounting for other confounding influences, particularly residual disease,” the authors concluded.


  1. Horowitz, Neil S., et al. “Does Aggressive Surgery Improve Outcomes? Interaction Between Preoperative Disease Burden and Complex Surgery in Patients With Advanced-Stage Ovarian Cancer: An Analysis of GOG 182.” Journal of Clinical Oncology. doi: 10.1200/JCO.2014.56.3106. February 9, 2015.