4.3. Patients

All women over 18 years old who presented advanced-stage HGSOC at our center during the study period were invited to participate if complete macroscopic CRS could be performed at primary or interval CRS. Advanced stage was defined by stage IIB-IV of the 2014 classification of the International Federation of Gynecology and Obstetrics (FIGO) [35].

The patients were treated in accordance with international recommendations after systematic pre-therapeutic validation during a multidisciplinary consultation. Our department of surgery is certified by the European Society of Gynecologic Oncology (ESGO) for the management of advanced stage EOC. An exploratory laparoscopy was performed to assess the resectability of the lesions. The Peritoneal Carcinomatosis Index (PCI) [36] and the laparoscopic Fagotti score [37] were used to quantify macroscopic peritoneal spread. Complete macroscopic CRS was performed by laparotomy at the same time as, or a few days after, laparoscopy. Macroscopic complete CRS included at least peritoneal cytology, total hysterectomy, bilateral salpingo-oophorectomy, infragastric omentectomy, appendectomy, and other surgical procedures allowing for the removal of all visible suspicious peritoneal lesions. Pelvic and para-aortic lymphadenectomy were performed according to the recommendations [38] and results of the LION study [39]. When there was no suspicion of radiological lymph node involvement during initial management or at palpation during surgery, we did not perform routine lymph node dissection.

The following clinical and pathological variables were collected: age, comorbidities, parity, surgical procedure, stage according to the 2014 FIGO classification [35], final pathological analysis, adjuvant therapies, date of recurrence, death or latest news.