Incidence and impact on survival outcomes of postoperative radiological evidence of residual disease in women with advanced stage ovarian cancer undergoing debulking surgery: a meta-analysis.

[OBJECTIVE] The present systematic review and meta-analysis aims to assess the proportion of patients with radiological findings of residual disease following debulking surgery and determine its impact on survival outcomes.

[METHODS] We systematically searched the international literature using the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar until July 2025 for studies that evaluated the proportion of patients with radiological evidence of residual disease following debulking surgery. The review was registered in PROSPERO prior to its conduct (CRD420251065596).

[RESULTS] Eleven studies were found eligible for inclusion in the present systematic review. Proportion meta-analysis indicated that 40% of patients had radiologic evidence of residual disease postoperatively (Generalized Mixed Linear Model 40%, 95% CI 33%, 48%). Differences in progression free survival were significantly worse among patients with residual disease (HR 2.08, 95% CI 1.42, 3.05). Similar findings were observed in the overall survival of patients (HR 1.93, 95% CI 1.49, 2.52).

[CONCLUSION] The proportion of patients with radiological criteria of residual disease following debulking surgery appears to be significant. There seem to be evidence that indicate a negative impact on survival outcomes of patients with epithelial ovarian cancer, although these should be interpreted cautiously given the heterogeneity and limitations of the available evidence, but may be relevant during preoperative patient counseling to help establish realistic expectations.