The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma

BACKGROUND. This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma. METHODS. One hundred six patients with a disease free interval (DFI) > 6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival. RESULTS. Eighty-seven patients (82.1%) underwent removal of all visible tumor. The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (< 10 cm [90.0%] vs. > 10 cm [66.7%]; P = 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given [64.3%] vs. chemotherapy not given [93.8%]; P = 0.001), and preoperative Gynecologic Oncology Group performance status (0 [100%], 1 [91.4%], 2 [82.4%], and 3 [47.4%]; P = 0.001). Survival was influenced by the DFI after primary treatment (6-12 months [median, 25.0 months] vs. 13-36 months [median, 44.4 months] vs. > 36 months [median, 56.8 months]; P = 0.005), the completeness of cytoreduction (visibly disease free [median, 44.4 months] vs. any residual disease [median, 19.3 months]; P = 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given [median, 24.9 months] vs. chemotherapy not given [median, 48.4 months]; P = 0.005), and the largest size of recurrent tumor (< 10 cm [median, 37.3 months] vs. > 10 cm [median, 35.6 months]; P = 0.04]). CONCLUSIONS. Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.