Secondary Cytoreductive Surgery In Patients Research Articles

A randomized phase II study of secondary cytoreductive surgery in patients with relapsed ovarian cancer who have progressed on a PARP inhibitor as first-line maintenance therapy: the SOCCER-P study (KGOG 3067/JGOG 3036/APGOT-OV11)

BackgroundAlthough two recent phase III randomized controlled trials showed survival benefits of undergoing secondary cytoreductive surgery for an initial relapse of ovarian cancer, patients who received a poly-ADP ribose polymerase...

Outcomes of secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer progressed after prior poly (adenosine diphosphate-ribose) polymerase inhibitors: A retrospective cohort study

ObjectiveTo evaluate the impact of previous poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor therapy on the effectiveness of secondary cytoreductive surgery (SCS) in patients with platinum-sensitive recurrent ovarian cancer (PSROC). MethodsWe identified patients with PSROC who underwent SCS at the Cancer Hospital, Chinese Academy of Medical Science, between January 2010 and December 2022. Postoperative complications within 30 days were categorized using the Accordion Severity Grading System. The Kaplan‒Meier method was used to estimate both overall survival (OS) and progression-free survival (PFS), and multivariate analysis was used to identify independent prognostic factors. ResultsOf the 265 patients included, 39 received prior PARP inhibitor therapy (Group A), and 226 did not (Group B). The rates of complete resection after SCS did not significantly differ between the two groups (79.5 % for Group A vs. 81.0 % for Group B; p = 0.766). As of December 2023, Group A exhibited a significantly shorter median PFS (14.2 months) than Group B (22.5 months; p = 0.002). Furthermore, the 3-year OS rate was lower in Group A (72.5 %) than in Group B (82.7 %; p = 0.015). The incidence of severe postoperative complications was comparable between Groups A and B (7.7 % vs. 1.8 %; p = 0.061). Multivariate analysis revealed that prior PARP inhibitor therapy significantly reduced the median PFS (hazard ratio (HR) = 4.434; p = 0.021) and OS (HR = 2.076; p = 0.010). ConclusionsSCS for PSROC demonstrated reduced efficacy in patients previously treated with PARP inhibitors compared to those without prior PARP inhibitor treatment.

Optimum selection criteria for secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer: A multicenter study from the Gynecologic Oncology Research Investigators coLLaborAtion group (GORILLA-3001).

To identify those most likely to benefit from secondary cytoreductive surgery (SCS), we evaluated the survival outcomes and factors predictive of prognosis in patients with recurrent ovarian cancer. We retrospectively reviewed the medical records of patients with recurrent ovarian cancer treated at five high-volume Korean hospitals between 2010 and 2021. Recurrence characteristics, treatment methods, and potential predictors of survival were compared between the chemotherapy and surgery groups. Among all 670 patients, 88.1% had initial stage III/IV disease, and 215 (32.1%) underwent SCS. Among patients who underwent SCS, only those who achieved complete resection exhibited improved survival. Even in patients with residual disease < 1 cm after SCS, we observed no significant survival benefit (p = 0.942). In the multivariate Cox analysis, residual disease at primary surgery, progression-free interval, recurrence sites (≤3 regions or limited carcinomatosis), ascites, and SCS were significant predictors of survival. Meanwhile, the only factor predictive of complete resection after SCS was recurrence sites (p < 0.001). The benefits of SCS appear to be exclusive to cases of complete resection. We propose limited regional platinum-sensitive recurrence (≤3 regions or limited carcinomatosis) without ascites as the optimum selection criteria for SCS.

Optimum selection criteria for secondary cytoreductive surgery in patients with recurrent ovarian cancer: A multicenter study from the Gynecologic Oncology Research Investigators coLLaborAtion (GORILLA) group (GORILLA 3001) (546)

Objectives: Optimum selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer is often dependent on multiple confounding factors. This study aimed to evaluate the treatment outcomes of recurrent ovarian cancer and investigate the factors identifying patients who most likely benefit from the SCS. Methods: We retrospectively reviewed medical records of recurrent ovarian cancer patients from five referral hospitals in Korea from 2010 to 2020. Recurrent characteristics, following treatment methods and potential factors for survivals were evaluated between the chemotherapy and surgery groups. Results: A total of 670 patients with recurrent ovarian cancer were identified. The patient’s median age was 55 years (24-83), and 88.1% of patients had initial stage III/IV disease. Of all patients, 215 (32.1%) received SCS for the disease recurrence. The median survival was 85 months (95% CI: 65.0-105.0) in the chemotherapy group, whereas the median survival time was not reached in the SCS group. Patients who received the SCS were more likely to be young and had no residual disease at primary surgery, platinum-sensitive recurrence, limited regional recurrence (LRR, ≤3 lesions or regional carcinomatosis) with a low rate of ascites (p<0.001, 0.001, 0.001, 0.001, 0.006, respectively). In multivariate cox analysis, residual disease at primary surgery, PFI, recurrent sites, ascites, and SCS were significant prognostic factors for survival. Meanwhile, predicting factor for complete resection after SCS was only recurrent sites (LRR, p<0.001). Conclusions: SCS resulted in significantly favorable survival outcomes in well-selected patients. Platinum-sensitive recurrence with limited regional diseases (< 3 regions or limited carcinomatosis without ascites) can be considered as optimum criteria for SCS in recurrent ovarian cancer. Objectives: Optimum selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer is often dependent on multiple confounding factors. This study aimed to evaluate the treatment outcomes of recurrent ovarian cancer and investigate the factors identifying patients who most likely benefit from the SCS. Methods: We retrospectively reviewed medical records of recurrent ovarian cancer patients from five referral hospitals in Korea from 2010 to 2020. Recurrent characteristics, following treatment methods and potential factors for survivals were evaluated between the chemotherapy and surgery groups. Results: A total of 670 patients with recurrent ovarian cancer were identified. The patient’s median age was 55 years (24-83), and 88.1% of patients had initial stage III/IV disease. Of all patients, 215 (32.1%) received SCS for the disease recurrence. The median survival was 85 months (95% CI: 65.0-105.0) in the chemotherapy group, whereas the median survival time was not reached in the SCS group. Patients who received the SCS were more likely to be young and had no residual disease at primary surgery, platinum-sensitive recurrence, limited regional recurrence (LRR, ≤3 lesions or regional carcinomatosis) with a low rate of ascites (p<0.001, 0.001, 0.001, 0.001, 0.006, respectively). In multivariate cox analysis, residual disease at primary surgery, PFI, recurrent sites, ascites, and SCS were significant prognostic factors for survival. Meanwhile, predicting factor for complete resection after SCS was only recurrent sites (LRR, p<0.001). Conclusions: SCS resulted in significantly favorable survival outcomes in well-selected patients. Platinum-sensitive recurrence with limited regional diseases (< 3 regions or limited carcinomatosis without ascites) can be considered as optimum criteria for SCS in recurrent ovarian cancer.

Olaparib beyond progression compared with platinum chemotherapy after secondary cytoreductive surgery in patients with recurrent ovarian cancer: phase III randomized, open-label MITO 35b study, a project of the MITO-MANGO groups

Olaparib beyond progression compared with platinum chemotherapy after secondary cytoreductive surgery in patients with recurrent ovarian cancer: phase III randomized, open-label MITO 35b study, a project of the MITO-MANGO groups

Olaparib beyond progression compared with platinum chemotherapy after secondary cytoreductive surgery in patients with recurrent ovarian cancer: phase III randomized, open-label MITO 35b study, a project of the MITO-MANGO groups

BackgroundPoly (ADP-ribose) polymerase inhibitors have transformed the management landscape for patients with ovarian cancer, demonstrating remarkable improvements in progression-free survival and overall survival. Unfortunately, most relapses are due to an...

Secondary Cytoreductive Surgery in Platinum-Sensitive Recurrent Ovarian Cancer: A Meta-Analysis.

The survival impact of secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer was studied. We identified published studies from 1983 to 2021 following our inclusion criteria from MEDLINE, EMBASE, and Cochrane library. To integrate the effect size of single-arm studies, meta-analysis was performed using death rate as a primary outcome. The effect of complete cytoreduction and optimal cytoreduction on survival was evaluated using meta-regression. The pooled death rate was presented with a 95% CI. The publication bias was evaluated with the funnel plot and Egger's test, and sensitivity analysis was performed. To overcome missing death rates, the linear regression model was performed on log-transformed median overall survival (OS) time using study size as a weight. Thirty-six studies with 2,805 patients reporting death rates were used for this meta-analysis of the 80 eligible studies. There was strong heterogeneity, with the P value of the Cochrane Q test of < 0.0001 and Higgins's I2 statistics of 86%; thus, we considered a random effect model. The pooled death rate was 44.2% (95% CI, 39.0 to 49.5), and both the complete and optimal cytoreductions were associated with better survival outcomes as significant moderators in the meta-regression model (P < .001 and P = .005, respectively). Although 14 studies were located outside the funnel plot, Egger's test indicated no publication bias (P = .327). A sensitivity analysis excluding 14 studies showed similar results. In the linear regression model on the basis of 57 studies, the median OS time increased by 8.97% and 7.04% when the complete and optimal cytoreduction proportion increased by 10%, respectively, after adjusting other variables. Secondary cytoreductive surgery, resulting in maximal tumor resection, significantly prolongs OS in platinum-sensitive recurrent ovarian cancer.

Outcomes of secondary cytoreductive surgery for patients with platinum-sensitive recurrent ovarian cancer

Most women with advanced epithelial ovarian cancer develop recurrent disease, despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. In observational studies, secondary cytoreductive surgery has been associated with improved survival; however its use is controversial, because there are concerns that the improved outcomes may reflect selection bias rather than the superiority of secondary surgery. To compare the overall survival of women with platinum-sensitive recurrent ovarian cancer treated at National Cancer Institute-designated cancer centers who receive secondary surgery vs chemotherapy. This retrospective cohort study included women from 6 National Cancer Institute-designated cancer centers diagnosed with platinum-sensitive recurrent ovarian cancer between January 1, 2004, and December 31, 2011. The primary outcome was overall survival. Propensity score matching was used to compare similar women who received secondary surgery vs chemotherapy. Additional analyses examined how these findings may be influenced by the prevalence of unobserved confounders at the time of recurrence. Among 626 women, 146 (23%) received secondary surgery and 480 (77%) received chemotherapy. In adjusted analyses, patients who received secondary surgery were younger (P= 0.001), had earlier-stage disease at diagnosis (P= 0.002), and had longer disease-free intervals (P < 0.001) compared with those receiving chemotherapy. In the propensity score-matched groups (n= 244 patients), the median overall survival was 54 months in patients who received secondary surgery and 33 months in those treated with chemotherapy (P < 0.001). Among patients who received secondary surgery, 102 (70%) achieved optimal secondary cytoreduction. There were no significant differences in complication rates between the 2 groups. In sensitivity analyses, the survival advantage associated with secondary surgery could be explained by the presence of more multifocal recurrences (if 4.3 times more common), ascites (if 2.7 times more common), or carcinomatosis (if 2.1 times more common) among patients who received chemotherapy instead of secondary surgery. Patients with platinum-sensitive recurrent ovarian cancer who received secondary surgery had favorable surgical characteristics and were likely to have minimal residual disease following secondary surgery. These patients had a superior median overall survival compared with patients who received chemotherapy, although unmeasured confounders may explain this observed difference.

Secondary Cytoreductive Surgery for Patients with Isolated Lymph Node Recurrence of Gynecologic Cancer

Secondary Cytoreductive Surgery for Patients with Isolated Lymph Node Recurrence of Gynecologic Cancer

Outcomes of secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer

Outcomes of secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer

Secondary cytoreductive surgery in recurrent epithelial ovarian cancer: A prognostic analysis with 103 cases

BackgroundDue to satisfactory cytoreductive surgery combined with platinum-based chemotherapy in epithelial ovarian cancer has improved greatly, however, the relapse rate also high. In current study, we analyzed prognostic factors related to secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer. MethodsClinical and follow-up data from 103 patients with recurrent epithelial ovarian cancer who received secondary cytoreductive surgery and were admitted to our hospital between January 2000 and December 2008 were analyzed. ResultsMedian survival after recurrence (RS) after the first relapse for the 103 patients was 36 months, and median overall survival (OS) was 60 months. Patients without visible residual tumors after secondary cytoreductive surgery had longer RS and OS compared to those with residual tumors ≥1 cm. The RS and OS of patients without visible residual tumors after secondary cytoreductive surgery were not significantly different compared to those with residual tumors between 0.1 and 1 cm. Patients with disease free interval (DFI) ≥ 12 months at secondary cytoreductive surgery had longer RS and OS compared to those with DFI < 12 months. Patients with one recurrent lesion had longer RS and OS compared to those with more than one lesion. ConclusionsResidual tumor at secondary cytoreductive surgery, DFI and number of lesions were independent prognostic factors for secondary cytoreductive surgery in patients with epithelial ovarian cancer. Patients with DFI ≥12 months and a single lesion had better prognosis for achieving satisfactory cytoreduction, especially the absence of visible residual tumors.

Benefits of fluorine-18 fludeoxyglucose positron emission tomography in secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer.

To investigate the benefits of fluorine-18 fludeoxyglucose positron emission tomography ((18)F-FDG-PET) in patients undergoing secondary cytoreductive surgery (SCRS) for recurrent epithelial ovarian cancer. Patients were identified, and their clinical information was extracted by review of the gynaecologic oncology database of Peking Union Medical College Hospital. (18)F-FDG-PET scan and analysis were performed by nuclear medicine experts at our hospital. The PET group and the control group of patients evaluated by conventional imaging methods differed significantly with respect to the proportion of patients who underwent complete SCRS and the number of residual lesions (p = 0.002 and 0.006, respectively). A Cox model showed that longer progression-free survival (PFS) correlated significantly with (18)F-FDG-PET evaluation [relative risk (RR) = 0.432; p = 0.001], sensitivity to platinum-based chemotherapies (RR = 0.604; p = 0.034) and resection completeness (RR = 0.679; p = 0.039). Longer overall survival (OS) correlated significantly with sensitivity to platinum-based chemotherapy (RR = 0.317; p = 0.000) and the CA-125 level after two cycles of chemotherapy (RR = 2.663; p = 0.003). Surgical safety and complications did not significantly differ between the two groups of patients. (18)F-FDG-PET is useful for evaluating patients with recurrent epithelial ovarian carcinoma. Patients who undergo PET-guided SCRS have a greater chance of complete tumour resection and a longer PFS. SCRS guided by PET results in fewer residual lesions. PET-guided SCRS is safe and can prolong PFS and OS in patients with recurrent ovarian cancer.

External validation of two prediction models of complete secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer

ObjectiveThe purpose of this study was to validate the performance of two prediction models, the AGO score and the Tian model, of complete secondary cytoreductive surgery (SCS) in patients with recurrent epithelial ovarian cancer. The predictive value of both models for survival controlled for the outcome of SCS was analyzed and known predictive factors for complete SCS were tested. MethodsA population-based database with 408 patients, who underwent SCS between 2000 and 2013 in 38 Dutch hospitals, was used. The validation cohorts for the AGO score and the model of Tian contained 273 (66.9%) and 257 (63.0%) patients, respectively. ResultsThe AGO score and Tian model showed a positive predictive value for complete SCS of 82.0% and 80.3% respectively, and a false negative rate of 68.5% and 55.6% respectively. A positive AGO score had no significant association with overall survival (HR 0.73; 95% CI 0.51–1.06) whereas the low risk score of the Tian model did (HR 0.62; 95% CI 0.41–0.93). A good performance status (OR 0.60; 95% CI 0.33–1.10) and the absence of ascites (OR 0.18; 95% CI 0.08–0.41) were prognostic factors for complete SCS. ConclusionsBoth the AGO score and the model of Tian showed a high positive predictive value for complete SCS but also relatively high false negative rates. However, before the two prediction models can be applied in daily clinical practice the usefulness of SCS itself has to be proven first by the three ongoing randomized controlled trials: DESKTOP III trial, the GOG 213 trial and the Dutch SOCceR trial.

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

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.

Secondary cytoreductive surgery in patients with isolated platinum-resistant recurrent ovarian cancer: A retrospective analysis

ObjectiveTo analyze the impact of secondary cytoreductive surgery (SCS) on survival outcome in a retrospective series of isolated platinum-resistant recurrent ovarian cancer. MethodsWe evaluate a consecutive series of 268 ovarian cancer patients with platinum-resistant relapse. Isolated recurrence was defined as the presence of a single nodule, in a single anatomic site, and was observed in 27 cases (10.1%). In all women the presence of isolated relapse was assessed at radiological evaluation, and surgically confirmed in the SCS group. ResultsAmong the 27 patients with isolated recurrence, 16 (59.3%) received chemotherapy alone, and 11 (40.7%) complete SCS followed by non-platinum based chemotherapy. No significant differences were observed in the distribution of baseline clinico-pathological characteristics, pattern of recurrent disease, duration of PFI, and type of salvage chemotherapy between the two groups. In the SCS group, 6 patients (54.5%) showed isolated peritoneal relapse and 5 women (45.4%) showed isolated lymph nodal recurrence, and were treated with peritonectomy and lymphadenectomy, according with site of relapse. Two post-operative complications (18.2%) occurred: asymptomatic lymphocele and groin wound dehiscence. SCS significantly prolonged median time to first progression (12months vs 3months; p-value=0.016), median time to second progression (8months vs 3months; p-value=0.037), and post-relapse survival (PRS) (32months vs 8months; p-value=0.002). Residual tumor at 1st surgery (X2=5.690; p-value=0.017), duration of PFI (X2=5.401; p-value=0.020), and complete SCS (X2=4.250; p-value=0.039) retains independent prognostic role for PRS in multivariate analysis. ConclusionsSCS prolongs PRS compared to chemotherapy alone in isolated platinum-resistant recurrent ovarian cancer.

The Role of Secondary Cytoreductive Surgery in Patients with Recurrent Epithelial Ovarian, Tubal, and Peritoneal Cancers: A Comparative Effectiveness Analysis

Background. All published reports concerning secondary cytoreductive surgery for relapsed ovarian cancer have essentially been observational studies. However, the validity of observational studies is usually threatened from confounding by indication. We sought to address this issue by using comparative effectiveness methods to adjust for confounding. Methods. Using a prospectively collected administrative health care database in a single institution, we identified 1,124 patients diagnosed with recurrent epithelial, tubal, and peritoneal cancers between 1990 and 2009. Effectiveness of secondary cytoreductive surgery using the conventional Cox proportional hazard model, propensity score, and instrumental variable were compared. Sensitivity analyses for residual confounding were explored using an array approach. Results. Secondary cytoreductive surgery prolonged overall survival with a hazard ratio (95% confidence interval) of 0.76 (range 0.66-0.87), using the Cox proportional hazard model. Propensity score methods produced comparable results: 0.75 (range 0.64-0.86) by nearest matching, 0.73 (0.65-0.82) by quintile stratification, 0.71 (0.65-0.77) by weighting, and 0.72 (0.63-0.83) by covariate adjustment. The instrumental variable method also produced a comparable estimate: 0.75 (range 0.65-0.86). Sensitivity analyses revealed that the true treatment effects may approach the null hypothesis if the association between unmeasured confounders and disease outcome is high. Conclusions. This comparative effectiveness study provides supportive evidence for previous reports that secondary cytoreductive surgery may increase overall survival for patients with recurrent epithelial, tubal, and peritoneal cancers.

A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: An evidence-based proposal for patient selection.

5053 Background: This study aims to redefine the role of secondary cytoreductive surgery (SCR) and develop a risk model for predicting outcomes of SCR in patients with recurrent ovarian cancer. Methods: Individual data of patients with recurrent ovarian cancer undergoing SCR from seven world-wide centers were pooled analyzed. The risk model was developed based on the factors impacting on SCR outcome. Additional data of 117 patients were used for external validation and to assess the discrimination of the model. Results: Complete SCR was strongly associated with the improvement of survival, with a median survival of 57.7 months, when compared to 27.0 months and 15.6 months in those with residual disease of 0.1-1cm and >1cm, respectively (P< 0.0001). Of the 1075 patients, 434 (40.4%) underwent complete resection. Complete SCR was associated with six variables: FIGO stage (OR=1.32), residual disease after primary cytoreduction (OR=1.69), progression-free interval (OR=2.27), ECOG performance status (OR=2.23), CA125 (OR=1.85) and ascites at recurrence (OR=2.79). These variables were entered into the risk model and assigned scores ranging from 0 to 11.9. Patients with total scores of 0-4.7 were categorized as the low risk group, in which the proportion of complete cytoreduction was 53.4% compared to 20.1% in the high risk group (OR=4.55). In external validation, the sensitivity and specificity of the model was 83.3% and 57.6%, respectively. Conclusions: SCR may be recommended for selected patients with recurrent ovarian cancer. This model may well predict the outcome of SCR and determine who benefit from SCR.

Secondary cytoreductive surgery: A key tool in the management of recurrent ovarian sex cord–stromal tumors

Objective: Therapeutic options for patients with recurrent malignant ovarian sex cord–stromal tumors (SCSTs) are limited. Secondary cytoreductive surgery (CS) has been shown to provide a survival advantage in select patients with epithelial ovarian cancer. We evaluated the role of secondary CS in patients with SCSTs of the ovary.

The Role of Secondary Cytoreductive Surgery for Patients with Recurrent Epithelial Ovarian Carcinoma

The Role of Secondary Cytoreductive Surgery for Patients with Recurrent Epithelial Ovarian Carcinoma

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

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.