Secondary cytoreductive surgery for recurrent ovarian cancer. A prospective study

Abstract

The prognosis for patients with recurrent epithelial ovarian cancer is poor. Most are treated with salvage chemotherapy. The role of secondary cytoreductive surgery is controversial. Hence, this prospective study was undertaken to determine the feasibility and benefit of secondary cytoreductive surgery before the administration of salvage chemotherapy. Between 1990 and 1994, 36 patients with recurrent epithelial ovarian cancer underwent secondary surgical cytoreduction. All had prior primary cytoreductive surgery, platin-based chemotherapy, and had relapsed at least 6 months after completion of primary treatment. The goal was the excision of all macroscopic disease before initiation of chemotherapy or radiation therapy. Statistical analysis was undertaken to determine which clinical and pathologic variables influenced the feasibility of complete excision as well as morbidity, mortality, survival benefit, and quality of life resulting from secondary cytoreductive surgery. Thirty (83.0%) patients had complete surgical excisions. The probability of a complete excision was influenced by Gynecologic Oncology Group (GOG) performance status (0-2 vs. 3, P = 0.05) and size of largest tumor deposit (< 10 cm vs. > 10 cm, P = 0.03). Eleven (30.1%) patients experienced morbidity and 1 (2.8%) died postoperatively. Of 27 symptomatic patients with at least 3 months of follow-up, 26 (96.2%) had resolution or improvement of their symptoms. Of 25 followed for at least 6 months postoperatively, 23 (92.0%) had a GOG performance status of 0 or 1. Survival was adversely influenced by the administration of salvage chemotherapy before surgery (P = 0.02), a preoperative GOG performance status of 3 (P = 0.01), and a brief disease free interval after completion of primary treatment (P = 0.01). The median survival was extended for patients completely resected before salvage chemotherapy or radiation, compared with those with macroscopic residual disease remaining (43 vs. 5 months, P = 0.03). Complete secondary cytoreductive surgery for recurrent epithelial ovarian cancer is technically feasible and has an acceptable operative complication rate. Survival is significantly improved for patients having complete resection. Subsequent relief of symptoms and performance status are excellent.