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Suboptimal primary cytoreductive surgery (residual disease ≥1 cm) or unresectable at pres...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-OVARIAN-SUBOPTIMAL-DEBULKING
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-OVARIAN
SourcesSRC-ESMO-OVARIAN-2024 SRC-NCCN-OVARIAN-2025

Red Flag Origin

DefinitionSuboptimal primary cytoreductive surgery (residual disease ≥1 cm) or unresectable at presentation in advanced (FIGO III-IV) ovarian carcinoma. MDT-trigger for neoadjuvant chemo (NACT) → interval debulking surgery (IDS) pathway per CHORUS / EORTC55971 trials, rather than primary debulking.
Clinical directioninvestigate
Categoryorgan-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "primary_debulking_residual_cm",
      "threshold": 1
    },
    {
      "finding": "primary_debulking_unsuccessful",
      "value": true
    },
    {
      "finding": "fagotti_score_high_unresectable",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Surgical-vs-NACT timing decision is the central MDT debate in advanced ovarian. Fagotti laparoscopic score predicts complete resection feasibility. Complete (R0) cytoreduction substantially improves PFS/OS — when achievable, primary debulking preferred. When R0 not achievable or patient frail/comorbid → NACT carbo+pacli × 3-4 cycles → IDS → 3 more cycles + maintenance.

Used By

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Indications