Debulking Surgery, Survival Outcomes, and Rehabilitation in Advanced Ovarian Cancer: A Narrative Review

Abstract

Complete macroscopic cytoreduction is the most robust modifiable prognostic factor in advanced epithelial ovarian cancer. However, the relative value of primary debulking surgery (PDS) versus interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT) is still debated, and the role of structured rehabilitation is often under-recognized. We performed a narrative review of 51 studies identified through Semantic Scholar re-trieval, including randomized trials, observational cohorts and meta-analyses. Eligible ar-ticles compared different extents and timings of cytoreductive surgery and/or evaluated structured postoperative or peri-operative exercise-based rehabilitation programs, report-ing survival, morbidity, functional or quality-of-life outcomes. Across the included stud-ies, complete or near-complete tumor removal was consistently associated with major im-provements in overall and progression-free survival. Median overall survival was approx-imately 58 months in patients with no gross residual disease versus about 22 months when postoperative residual tumor exceeded 1 cm. When complete resection was achieved, IDS following NACT yielded survival outcomes comparable to PDS, whereas in the presence of residual disease, PDS generally provided superior long-term results. In high-volume centers, morbidity ranged between 14–24% and mortality remained below 2.5%, with complications mainly related to bowel resection, infection, and thromboembol-ic events. Structured rehabilitation improved aerobic capacity, reduced fatigue, enhanced physical functioning, and was associated with better adherence to adjuvant chemothera-py. Survival in advanced epithelial ovarian cancer is primarily driven by the complete-ness of cytoreduction, while functional recovery and treatment fidelity are substantially enhanced by targeted, exercise-based rehabilitation. An integrated care model combining maximal-effort cytoreductive surgery with structured rehabilitation appears central to op-timizing outcomes.