The Role of Secondary Cytoreductive Surgery for Recurrent Ovarian Cancer

Abstract

To evaluate the efficacy of salvage therapy in the treatment of recurrent stage III ovarian cancer, the authors conducted a review of 75 patients treated for recurrent invasive ovarian cancer at their cancer centers between 1994 and 2003. Forty-four women underwent a secondary cytoreduction before additional chemotherapy and 31 were treated with chemotherapy alone. Study patients had been disease-free for at least 6 months (average interval, 26-27 months), and had no extrapelvic or extraabdominal disease at the time of recurrence. Paclitaxel or platinum-based chemotherapy was used most often for treatment of recurrent disease. The most frequent surgical procedures included 7 ileal resections and anastomoses, 14 pelvic mass excisions, and 9 peritoneal implant excisions. Optimal cytoreduction (largest remaining tumor less than 1 cm in diameter) was achieved in 77% of patients who underwent secondary cytoreductive surgery. Women with a single large tumor were more likely to be treated with secondary cytoreductive surgery, and those with multiple small tumors were more likely to receive chemotherapy alone. Sixty-four percent of women who underwent salvage surgery had a single tumor recurrence and 71 % of chemotherapy-alone patients had multiple tumors (P = .003). Ninety-four percent of women with tumors smaller than 5 cm received chemotherapy alone compared with 63.6% of women who underwent salvage surgery (P = .002). Patients who underwent surgical salvage treatment had a median survival of 16 months compared with a median survival of 12 months in those who received chemotherapy alone (P = .03). Women who had optimal tumor reduction had a significantly longer median survival than those with suboptimal reduction (19 months vs. 9 months, P = .007). Survival was not related to the length of disease-free interval, to the number of recurrences, or to the size of the recurrence. There were no operative deaths. Postoperative complications that required reoperation included one each severe hemorrhage, anastomosis leakage, enterocutaneous fistula, and evisceration. Minor complications included 5 superficial wound infections, 2 mechanical small bowel obstructions, and 5 postoperative fevers. All patients who underwent salvage surgery survived at least 4 months.