Secondary cytoreductive surgery in patients presenting with isolated nodal recurrence of epithelial ovarian cancer

Abstract

Objectives To evaluate the role of secondary cytoreductive surgery in the management of patients with isolated nodal recurrence of epithelial ovarian cancer. Methods In this retrospective study, the data of 21 patients submitted to secondary cytoreductive surgery for isolated nodal recurrence were reviewed. All clinical characteristics at initial treatment and relapsing disease, operative and pathologic data of secondary cytoreduction and follow-up information were abstracted from the files and evaluated. Results Median age at initial treatment was 50 years; 15 patients (71%) had FIGO stage III/IV disease. Following primary surgical and systematic treatment, isolated nodal recurrence was diagnosed after a median DFI of 21 months (range 8–156). Location of nodal disease was pelvic in 4, paraaortic in 8, pelvic plus paraaortic in 4, inguinal in 4 and in the axilla in 1 of the patients. Median tumor size was 3 cm. CA-125 levels > 35 U/ml were present in 13 cases. Complete cytoreduction was achieved in 17 (81%) and optimal (≤ 1 cm) in another 2 (9.5%) of the patients. There was 1 incident of serious intraoperative bleeding. Median estimated blood loss was 200 ml and median hospital stay 5 days. After SCS all patients were treated with chemotherapy (20/21) and/or RT (4/21). At the end of a median follow-up of 45 months, 10 patients were alive and well, 6 alive with disease and 5 were dead. Median post-recurrence survival was 47 months and projected 5-year post-recurrence survival 68%. Median overall survival after initial diagnosis was 66 months. Conclusion In selected patients presenting with ILNR optimal cytoreduction is possible in most of the cases with low perioperative morbidity. Combined with post-operative treatment, SCS results in a favorable outcome. More data are needed to better define the role of surgery in these patients.