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Secondary Cytoreductive Surgery for Recurrent Epithelial Ovarian Cancer

From the Gynaecological Cancer Centre, Royal Hospital for Women, Department of Obstetrics and Gynaecology, University of New South Wales, Sydney, Australia; and National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia.

Address reprint requests to: Neville F. Hacker, MD, Royal Hospital for Women, Gynaecological Cancer Centre, Department of Obstetrics and Gynaecology, Barker Street, Randwick NSW 2031, Australia; E-mail: n.hacker{at}unsw.edu.au.

OBJECTIVE: To review our experience with secondary cytoreductive surgery for recurrent epithelial ovarian cancer with regard to its feasibility, morbidity, mortality, patient selection, and survival.

METHODS: Forty-six patients who underwent secondary cytoreductive surgery at the Royal Hospital for Women, Sydney, between July 1988 and October 1996 were retrospectively reviewed. The mean age at surgery was 50.3 years, and the median disease-free interval was 26 months. Eighty-nine percent of patients had a disease-free interval of at least 12 months. Twenty-five patients (54%) had localized disease at the time of surgery. Univariate survival outcomes were analyzed using the log rank test, and survival curves were calculated using the method of Kaplan-Meier.

RESULTS: Two patients (4%) were inoperable and 19 patients (41%) were cytoreduced to no macroscopic disease. There was one postoperative death (2%), and four patients (8.7%) had significant postoperative morbidity. With a median follow-up of 88 months, the overall median survival was 22.5 months. Patients with a disease-free interval of less than 12 months after their initial treatment had a median survival of 6 months, compared with 11 months if the disease-free interval was 12–24 months and 39 months for those with a disease-free interval of 24 months or more (P = .001, log rank). Patients who had any residual disease had a median survival of 11 months, whereas those with no residual disease had a median survival of 38 months (P = .002, log rank).

CONCLUSION: For carefully selected patients with recurrent epithelial ovarian cancer: 1) complete surgical resection is feasible more commonly than with primary cytoreduction, 2) serious morbidity and mortality are acceptable, and 3) significant survival benefit accrues when a) all macroscopic disease can be resected, or b) the disease-free interval is 24 months or more.

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