The role of secondary cytoreduction in low-grade serous ovarian cancer or peritoneal cancer

Abstract

ObjectivesWe sought to determine the benefit of secondary cytoreductive surgery (SCRS) in patients with low-grade serous ovarian or peritoneal carcinoma, and whether cytoreduction to no gross residual disease affects survival. MethodsA single institution retrospective chart review was conducted in patients with recurrent low-grade serous carcinoma who underwent SCRS between 1995 and 2012. Data including demographics, survival, chemotherapy, disease characteristics at the time of surgery, residual disease, and operative complications were collected. Overall survival (OS) and progression-free survival (PFS) were calculated. Kaplan–Meier and log-rank tests were used to examine survival outcomes. ResultsForty-one patients met inclusion criteria. The median time between primary tumor debulking and SCRS was 33.2months. Of 41 eligible patients who underwent SCRS, 32 (78%) had gross residual disease at the completion of secondary surgery. The median PFS for patients with no gross residual disease after SCRS was 60.3months, compared to 10.7months for patients with gross residual disease (p=0.008). Median OS from diagnosis for patients with no gross residual disease after SCRS was 167.5months compared to 88.9months (p=0.10). Median OS from the time of SCRS for patients with no gross residual disease was 93.6months compared to 45.8months (p=0.04). Complications occurred in 61% of patients after SCRS; there were no deaths directly attributable to surgery. ConclusionOur results suggest a benefit to SCRS in patients with recurrent low-grade serous carcinoma. Efforts to maximally cytoreduce patients should be made as patients with no gross residual disease had a better PFS and a trend toward better OS.