Tertiary Cytoreduction for Recurrent Epithelial Ovarian Cancer: a Multicenter Study in Turkey

Abstract

Background: The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC. Materials and Methods: Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05. Results: Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III-IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery . Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis. Conclusions: Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected.

Recurrent Ovarian Cancer with the Involvement of Urinary Organs: is There Place for Secondary Cytoreductive Surgery?

“…It leads to high rates of intestinal obstruction and fistula formation in the postoperative period. According to the published data, locoregional recurrence rate is 24-6% [6,7,[8][9][10]. In the present study, this rate was 11.3% (5 local and 2 systemic).…”

Management of oligometastatic ovarian cancer recurrence during PARP inhibitor maintenance

“…The role of tertiary cytoreductive surgery is debatable,30–35 but it has shown a survival benefit in selected patients achieving complete gross resection 35. In our study, 40% of patients were treated with surgery at second recurrence and all had no residual disease.…”

Surgery for Recurrent Ovarian Cancer

“…In a multi-centre retrospective review of 406 patients [84], based over a 16-year period, it was reported that residual tumour after secondary and tertiary surgery was an important prognostic factor and surgical outcome was compromised by ascites and upper abdominal disease. Avras et al [85] reported that the surgical goal, as with first recurrence, should be complete cytoreduction as this improved overall survival. The usual factors to be considered for surgery in recurrent disease with the goal of complete cytoreduction, such as disease-free interval, were reported but they also found an association with increased size of recurrent disease and reduced benefit from surgery.…”