A prospective comparison of resectability scores to enhance preoperative decision-making in the primary management of advanced ovarian cancer: a Memorial Sloan Kettering Cancer Center Team Ovary study
To compare cytoreductive outcomes of 2 published algorithms used to triage patients with ovarian cancer to primary debulking surgery versus diagnostic laparoscopy or neoadjuvant chemotherapy. This prospective comparative study was conducted from August 1, 2021, to January 31, 2025. All patients with suspected advanced ovarian cancer who were eligible for primary debulking surgery on initial evaluation were identified. Imaging was reviewed utilizing a standardized radiology synoptic report. Data from the synoptic report were combined with clinical factors to determine a Resectability Score using 1 of 2 algorithms, Resectability Score 1.0 (RS1.0) and Resectability Score 2.0 (RS2.0). The algorithms include different clinical and radiologic variables; both generate low- and high-risk scores, with high-risk scores indicating a greater likelihood of suboptimal primary debulking surgery. In high-risk cases, laparoscopic evaluation of resectability was recommended, but management was based on surgeon's discretion. Of 237 patients identified, 200 had primary debulking surgery with final pathology confirming epithelial ovarian carcinoma. Of 144 patients (72%) who underwent laparotomy and primary debulking surgery, 110 (76%) were triaged directly to surgery and 34 (24%) first underwent diagnostic laparoscopy; 120 (83%) had complete gross resection, 135 (94%) had residual disease ≤1 cm, and 9 (6%) had residual disease >1 cm. Of 56 patients (28%) who underwent neoadjuvant chemotherapy, 43 (77%) first underwent diagnostic laparoscopy, and 13 (23%) were triaged directly to chemotherapy. Among all patients, 44 (22%) had high-risk scores using RS1.0 and 54 (27%) using RS2.0. RS2.0 more frequently predicted the ability to and inability to achieve complete gross resection (p > .05). RS2.0 more accurately identified high-risk disease warranting neoadjuvant chemotherapy (p = .035). Most surgeons (73%) preferred RS2.0, citing ease of use and faster calculation time. RS2.0 demonstrated favorable predictive accuracy for complete gross resection and was preferred among surgeons. The favorable complete gross resection rate (83%) highlights the value of individualized preoperative triage for primary debulking surgery versus neoadjuvant chemotherapy.
