Secondary Cytoreductive Surgery at Second-Look Laparotomy in Advanced Ovarian Cancer: A Gynecologic Oncology Group Study

Abstract

Reports which analyzed the effects of secondary cytoreductive surgery at second-look laparotomy have often included small numbers of patients who have been treated with a variety of first-line chemotherapy regimens and those who may have progressed on first-line therapy. The purpose of this study was to analyze survival following secondary cytoreductive surgery at second-look laparotomy in patients with advanced ovarian cancer. Review of the surgical data of 153 patients allowed classification of tumor size found at second-look laparotomy and tumor size remaining after cytoreduction. Multivariate analysis evaluated multiple risk factors for survival. Of 153 patients, 124 had macroscopic tumor at second-look laparotomy and 29 had microscopic disease only. Fifteen of 69 (22%) patients were found to have tumor >1 cm in diameter and were cytoreduced to microscopic residual and 18/69 (26%) were left with 1 cm tumor. Twenty-one of 55 (38%) patients with ≤1 cm tumor were debulked to microscopic residual. The shortest survival relative to patients found to have microscopic disease at second-look laparotomy was observed among patients whose maximum tumor size remained >1 cm following second-look laparotomy (relative risk = 3.1,P= 0.0004). No difference in survival was seen between patients found to have microscopic disease and those cytoreduced to microscopic disease (P= 0.24). The risk of death was lower among patients debulked to a lower category (≤1 cm debulked to microscopic, relative risk = 0.48,P= 0.02; >1 cm reduced to ≤1 cm, relative risk = 0.49,P= 0.02; >1 cm reduced to microscopic, relative risk = 0.44,P= 0.01). Whether this apparent beneficial effect of cytoreductive surgery at second-look laparotomy reflects the biology of the tumor which allows surgical cytoreduction or the effects of cytoreduction can only be addressed in a randomized prospective trial.