Secondary cytoreductive surgery in the management of platinum-sensitive recurrent epithelial ovarian cancer.

BACKGROUND AND OBJECTIVES: To assess the surgical and survival outcomes after secondary cytoreductive surgery (SCRS) in patients with platinum-sensitive recurrent epithelial ovarian cancer (EOC) and to identify patients who would most benefit from SCRS.

METHODS: Inclusion criteria consisted of (1) recurrent EOC; (2) disease-free interval (DFI) >or=6 months after primary therapy; and (3) SCRS with therapeutic intent followed by adjuvant chemotherapy.

RESULTS: Sixty-seven patients met the inclusion criteria in the interval 1992-2008. Median DFI was 20 months (range: 6-109 months). Median time in surgery was 240 min (range: 60-680 min), and median estimated blood loss was 100 ml (range: 50-3,000 ml). There was no significant perioperative complication requiring reoperation. Complete resection of all visible tumor tissue was achieved in 37 patients (55.2%), with residual tumors (RT) <or=1 cm remaining in four patients (6%). After a mean follow-up of 41 months (range: 6-145 months), the 2- and 5-year disease-free survival (DFS) rates were 32% and 10%, respectively, and the 2- and 5-year overall survival (OS) rates were 58% and 26%, respectively. In multivariable analysis, DFI >24 months and RT <or=1 cm were significant predictors of DFS and OS.

CONCLUSIONS: SCRS is safe and effective, with a low rate of complications. Patients who benefited most from this surgery were those with a DFI >24 months and patients who achieved optimal cytoreduction.