Objectives: We sought to examine the oncologic outcomes of secondary cytoreductive surgery (SCS) pre/post FDA approval of Poly (ADP-ribose) polymerase inhibitors (PARPi) maintenance therapy for recurrent ovarian cancer (OC). Methods: Patients (pts) who underwent SCS for their first recurrent platinum-sensitive OC from January 1, 2013, to January 1, 2020, were identified. Pts with prior chemotherapy for recurrent disease or procedures performed for bowel obstruction or palliative intent were excluded. Data were dichotomized for pre/post-January 2017 (PreP)/ (PostP), the year of FDA approval for PARPi maintenance in recurrent OC. The histologic subtype, BRCA status, surgical approach, SCS residual disease (RD): >1 cm, 0.6-1 cm, <0.5cm, complete gross resection (CGR), rate of PARPi maintenance, and subsequent disease status were abstracted. The use of bevacizumab maintenance and heated intraperitoneal chemotherapy (HIPEC) in second-line management was also identified. PFS2 was defined as progression-free survival (PFS) from the date of SCS. Standard statistical tests were utilized. Results: In total, 245 pts were identified, including 131 (53%) PreP and 114 (47%) PostP. High-grade serous histology was present in 109/131 (83%) PreP and 103/114 (90%) PostP (p=0.13). Among the pts tested, BRCA1/2 mutations were identified in 32/120 (27%) PreP, 32/113 (28%) PostP (p=0.88). Disease-free interval following primary therapy was 6-12 months in 21/131 (16%) PreP and 20/114 (17.5%) PostP; 12-30 months in 73/131 (56%) PreP and 67/114 (59%) PostP; >30 months in 37/131 (28%) PreP and 27/114 (24%) PostP (p=0.79). SCS was performed via laparotomy in 106/131 (81%) PreP and 87/114 (76%) PostP, by laparoscopy /robotic in 22/131 (17%) PreP and 23/114 (20%) PostP and by other surgical approaches in 3/131 (2%) PreP and 4/114 (4%) PostP (p=0.73). CGR was achieved in 112/131(85%) PreP and 98/114 PostP (86%) (p>0.99). Of the 35 pts who had residual disease, 17/35 (48.5%) had 1-5 mm RD, 1/35 (3%) had 6-10mm RD, and 17/35 (48.5%) were suboptimal (>1cm). Upon completing SCS and chemotherapy, PARPi maintenance was used in 5/131 (4%) PreP and 31/114 (27%) PostP (p<0.001). Bevacizumab was used in 2/131 (1.5%) PreP and 14/114 (12%) PostP (p<0.001). HIPEC was used in 22/131 PreP (17%) and 19/114 (17%) PostP (p>0.99). Median PFS2 was 19 months (95%CI, 17-23) in PreP and 20.1 months (95%CI, 17-26) in PostP. In PostP, 84.5% CGR pts achieved 1-year PFS2 (95% CI: 75.5-90.4) and 31.3% achieved 3-year PFS2 (95% CI: 21.6-41.4) compared to patients with residual disease, 56.2% (95% CI: 29.5-76.2) and 12.5% (95% CI: 2.1-32.8) of whom achieved 1-year PFS2 and 3-year PFS2, respectively (p=0.001). Conclusions: In this analysis, the use of PARPi maintenance therapy for the first recurrent platinum-sensitive ovarian cancer markedly increased following its FDA approval in 2017. Optimal secondary cytoreductive surgery maintained a benefit to oncologic outcomes in this setting. In concert with expanding systemic therapy options, surgical resection remains a valuable component in the evolving management of recurrent ovarian cancer. Objectives: We sought to examine the oncologic outcomes of secondary cytoreductive surgery (SCS) pre/post FDA approval of Poly (ADP-ribose) polymerase inhibitors (PARPi) maintenance therapy for recurrent ovarian cancer (OC). Methods: Patients (pts) who underwent SCS for their first recurrent platinum-sensitive OC from January 1, 2013, to January 1, 2020, were identified. Pts with prior chemotherapy for recurrent disease or procedures performed for bowel obstruction or palliative intent were excluded. Data were dichotomized for pre/post-January 2017 (PreP)/ (PostP), the year of FDA approval for PARPi maintenance in recurrent OC. The histologic subtype, BRCA status, surgical approach, SCS residual disease (RD): >1 cm, 0.6-1 cm, <0.5cm, complete gross resection (CGR), rate of PARPi maintenance, and subsequent disease status were abstracted. The use of bevacizumab maintenance and heated intraperitoneal chemotherapy (HIPEC) in second-line management was also identified. PFS2 was defined as progression-free survival (PFS) from the date of SCS. Standard statistical tests were utilized. Results: In total, 245 pts were identified, including 131 (53%) PreP and 114 (47%) PostP. High-grade serous histology was present in 109/131 (83%) PreP and 103/114 (90%) PostP (p=0.13). Among the pts tested, BRCA1/2 mutations were identified in 32/120 (27%) PreP, 32/113 (28%) PostP (p=0.88). Disease-free interval following primary therapy was 6-12 months in 21/131 (16%) PreP and 20/114 (17.5%) PostP; 12-30 months in 73/131 (56%) PreP and 67/114 (59%) PostP; >30 months in 37/131 (28%) PreP and 27/114 (24%) PostP (p=0.79). SCS was performed via laparotomy in 106/131 (81%) PreP and 87/114 (76%) PostP, by laparoscopy /robotic in 22/131 (17%) PreP and 23/114 (20%) PostP and by other surgical approaches in 3/131 (2%) PreP and 4/114 (4%) PostP (p=0.73). CGR was achieved in 112/131(85%) PreP and 98/114 PostP (86%) (p>0.99). Of the 35 pts who had residual disease, 17/35 (48.5%) had 1-5 mm RD, 1/35 (3%) had 6-10mm RD, and 17/35 (48.5%) were suboptimal (>1cm). Upon completing SCS and chemotherapy, PARPi maintenance was used in 5/131 (4%) PreP and 31/114 (27%) PostP (p<0.001). Bevacizumab was used in 2/131 (1.5%) PreP and 14/114 (12%) PostP (p<0.001). HIPEC was used in 22/131 PreP (17%) and 19/114 (17%) PostP (p>0.99). Median PFS2 was 19 months (95%CI, 17-23) in PreP and 20.1 months (95%CI, 17-26) in PostP. In PostP, 84.5% CGR pts achieved 1-year PFS2 (95% CI: 75.5-90.4) and 31.3% achieved 3-year PFS2 (95% CI: 21.6-41.4) compared to patients with residual disease, 56.2% (95% CI: 29.5-76.2) and 12.5% (95% CI: 2.1-32.8) of whom achieved 1-year PFS2 and 3-year PFS2, respectively (p=0.001). Conclusions: In this analysis, the use of PARPi maintenance therapy for the first recurrent platinum-sensitive ovarian cancer markedly increased following its FDA approval in 2017. Optimal secondary cytoreductive surgery maintained a benefit to oncologic outcomes in this setting. In concert with expanding systemic therapy options, surgical resection remains a valuable component in the evolving management of recurrent ovarian cancer.