Comparison of clinical and cost outcomes between primary and interval debulking surgery in ovarian cancer.

Abstract

Introduction: While neoadjuvant chemotherapy with interval debulking surgery (IDS) has comparable clinical outcomes to primary debulking surgery (PDS) for advanced epithelial ovarian cancer, their economic dimension remains understudied.

Methods: This retrospective chart review examined Stage IIIC-IV epithelial ovarian cancer patients who underwent IDS or PDS between 2011 and 2014. We compared the demographics, disease-specific, intraoperative, thirty-day clinical outcome and billing, and ten-year survival data.

Results: Patients who underwent PDS (n = 36) and IDS (n = 43) had similar characteristics, including age, comorbidity, cancer stage, cell type, nationality, and 30-day median bill sizes (SGD 31,649.69 vs. SGD 35,326.02). The IDS group had lower postoperative sepsis (2.3% vs. 16.7%), gastrointestinal complications (0.0% vs. 11.1%) and suboptimal debulking (14.0% vs. 33.3%) rates, shorter median hospital stay (5 vs. 8 days) and higher rates of complete gross resection (CGR) (62.8% vs. 36.1%) (all P < 0.05). There were significant associations between thirty-day complications and mucinous adenocarcinomas (odds ratio [OR] 10.8), packed cell transfusion (OR 1.87 per unit), and suboptimal debulking (OR 6.33). Thirty-day readmission or death was significantly associated with Clavien-Dindo Grade I-II complications (OR 46.8) and suboptimal debulking (OR 8.24). While PDS and IDS groups had similar ten-year survival (37.0% vs. 16.2%), PDS conferred a significantly lower recurrence rate (66.7% vs. 83.7%, P = 0.003).

Conclusion: The thirty-day cost and ten-year survival of IDS and PDS are comparable. Although IDS offers lower postoperative sepsis and gastrointestinal complications, shorter hospital stays and higher CGR rates, the ten-year recurrence is higher.