Liver-directed surgical procedures during cytoreductive surgery for stage IV ovarian cancer

The incorporation of liver-directed surgical procedures into cytoreductive surgery represents a challenge in stage IV epithelial ovarian cancer. Overall, 49 patients undergoing primary or interval debulking surgery with at least one hepatobiliary procedure were retrospectively analyzed. One intraoperative complication occurred and severe postoperative morbidity (grade III or higher according to the Clavien-Dindo classification) was observed in 8 (16.4%) patients. Only one of these complications (biliary leakage requiring endoscopic stenting) was directly attributable to liver surgery. Although limited by the small sample size, these findings suggest that, in carefully selected patients and within a multidisciplinary framework, hepatobiliary surgery can be safely incorporated into cytoreductive strategies to achieve complete tumor removal.