Unresectable Ovarian Cancer Requires a Structured Plan of Action: A Prospective Cohort Study

SIMPLE SUMMARY: Patients with unresectable ovarian cancer during cytoreductive surgery for advanced-stage ovarian cancer are typically underreported. Hence, knowledge of further postoperative treatment and survival in case of unresectable disease during surgery is limited. The aim of this study is to address the knowledge gap about postoperative treatment and survival of patients whose surgery was abandoned due to unresectability after abdominal exploration. This is a post hoc analysis of the PlaComOv study, a randomized controlled trial. In this prospective study, 27 patients with the unresectable disease are described. Treatment was divers, ranging from the cessation of treatment to, predominantly, one or several lines of chemotherapy with or without maintenance treatment with bevacizumab and/or PARP inhibitors. The median overall survival after surgery was 16 (IQR 5–21) months (95%CI 14–18). At 24 months of follow-up, four patients (15%) were alive with the disease. ABSTRACT: Background: Patients with unresectable disease during cytoreductive surgery (CRS) for advanced-stage ovarian cancer are underreported. Knowledge of treatment and survival after surgery is limited. The aim of this study is to address the knowledge gap about postoperative treatment and survival of patients whose surgery was abandoned due to unresectability after abdominal exploration. Methods: Women with FIGO stage IIIB-IV epithelial ovarian cancer whose disease was considered to be unresectable during surgery were included in this prospective study, a post hoc analysis of the PlaComOv study. The unresectable disease was defined as the inability to achieve at least suboptimal CRS without attempted CRS after careful inspection of the entire abdomen. Preoperative clinical data, perioperative findings, postoperative treatment and survival data were analyzed. Results: From 2018 to 2020, 27 patients were included in this analysis. Treatment ranged from the cessation of treatment to one or several lines of chemotherapy with or without maintenance therapy. The median overall survival was 16 (IQR 5–21) months (95%CI 14–18). At 24 months of follow-up, four patients (15%) were alive. Conclusions: This study indicated a two-year survival of 15%. Optimal treatment strategies in terms of survival benefits are still ill-defined. Further study of this specific group of patients is warranted. We advocate an (inter)national registry of patients with unresectable cancer and comprehensive follow-up.