A Cochrane review included 3 studies with a total of 853 women of whom 781 were evaluated. Secondary surgery, performed after a few cycles of chemotherapy before proceeding to further cycles of chemotherapy, is called interval debulking surgery (IDS). Overall survival (OS) showed substantial heterogeneity between trials. Subgroup analysis for overall survival in two trials, wherein the primary surgery was not performed by the gynecologic oncologists, showed benefit of IDS (HR 0.7, 95% CI 0.5 to 0.9, I2 = 0%). Rates of toxic reactions to chemotherapy were similar in both arms, but little information is available for other adverse events. Only one trial reported quality of life (QOL), which was generally similar in both treatment arms.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies), by indirectness (differences in studied patients and expertise of surgeons), and by imprecise results (limited study size for each comparison).