Secondary cytoreductive surgery in the management of platinum-sensitive recurrent epithelial ovarian cancer

• Published in: Journal of surgical oncology Vol. 101; no. 5; pp. 418 - 424
• Main Authors: Park, Jeong-Yeol, Eom, Jeong-Min, Kim, Dae-Yeon, Kim, Jong-Hyeok, Kim, Yong-Man, Kim, Young-Tak, Nam, Joo-Hyun
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-04-2010
• Subjects: Adult; Aged; Cisplatin - therapeutic use; epithelial ovarian cancer; Female; Humans; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Neoplasms, Glandular and Epithelial - drug therapy; Neoplasms, Glandular and Epithelial - mortality; Neoplasms, Glandular and Epithelial - surgery; optimal debulking; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - mortality; Ovarian Neoplasms - surgery; recurrent ovarian cancer; secondary cytoreduction
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.21470

Background and Objectives
To assess the surgical and survival outcomes after secondary cytoreductive surgery (SCRS) in patients with platinum‐sensitive recurrent epithelial ovarian cancer (EOC) and to identify patients who would most benefit from SCRS.
Methods
Inclusion criteria consisted of (1) recurrent EOC; (2) disease‐free interval (DFI) ≥6 months after primary therapy; and (3) SCRS with therapeutic intent followed by adjuvant chemotherapy.
Results
Sixty‐seven patients met the inclusion criteria in the interval 1992–2008. Median DFI was 20 months (range: 6–109 months). Median time in surgery was 240 min (range: 60–680 min), and median estimated blood loss was 100 ml (range: 50–3,000 ml). There was no significant perioperative complication requiring reoperation. Complete resection of all visible tumor tissue was achieved in 37 patients (55.2%), with residual tumors (RT) ≤1 cm remaining in four patients (6%). After a mean follow‐up of 41 months (range: 6–145 months), the 2‐ and 5‐year disease‐free survival (DFS) rates were 32% and 10%, respectively, and the 2‐ and 5‐year overall survival (OS) rates were 58% and 26%, respectively. In multivariable analysis, DFI >24 months and RT ≤1 cm were significant predictors of DFS and OS.
Conclusions
SCRS is safe and effective, with a low rate of complications. Patients who benefited most from this surgery were those with a DFI >24 months and patients who achieved optimal cytoreduction. J. Surg. Oncol. 2010; 101:418–424. © 2010 Wiley‐Liss, Inc.