Role of secondary cytoreductive surgery in ovarian cancer relapse: Who will benefit? A systematic analysis of 240 consecutive patients

Abstract

Background and Objectives In contrast to primary ovarian cancer, the value of surgery in relapsed‐OC (ROC) remains unclear. We evaluated surgical and clinical outcome of secondary cytoreduction in ROC. Methods All consecutive ROC patients who underwent secondary tumor‐debulking surgery were systematically analyzed as based on a validated intraoperative documentation tool. Tumor dissemination pattern, operative and clinical outcome were evaluated. Cox‐regression analysis was performed to identify independent predictors of mortality. Results Between 09/2000 and 10/2008, 240 operations were evaluated; 184 patients (81.1%) were platinum‐sensitive and 43 (20%) platinum‐resistant. 47.5% of the patients had ascites, while 85.8% presented a multifocal tumor dissemination pattern. In 53.8% a complete tumor resection was achieved; in another 24.2%, postoperative tumor residuals were 500 ml (HR: 6.76; 95% CI: 3.77–12.1), platinum resistance (HR: 3.1; 95% CI: 1.26–7.7), and initial FIGO stage IV (HR: 2.86; 95% CI: 1.16–7) were the most significant risk factors for mortality. Median OS was 42.3 months (95% CI: 24.37–60.2); 17.7 months (95% CI: 12.27–23.13); and 7.7 months (95% CI: 3.1–12.3) for patients with complete tumor resection, tumor residuals ≤1 and >1 cm, respectively (trend P‐value <0.001). Conclusions Absence of ascites, platinum‐sensitivity, initial FIGO stage <IV, and complete tumor resection correlate with a significantly better long‐term prognosis after ROC surgery. However, a significant trend of continuously improving survival associated with increasing tumor reduction rates could be identified even in patients where a complete tumor resection is not achievable. J. Surg. Oncol. 2010;102:656–662.