APICAL VAGINAL RECURRENCE OF OVARIAN-CARCINOMA - PRESENTATION, TREATMENT AND SURVIVAL

The object of this study was to evaluate the incidence, presenting sym ptoms, treatment, and survival of patients with recurrence of ovarian carcinoma at the vaginal apex. The charts of 19 patients with recurren t ovarian carcinoma at the vaginal apex diagnosed and treated between January, 1971 and December, 1993 were reviewed retrospectively. Statis tical analysis was carried out using the nonparametric Wilcoxon rank-s um test and survival rates were calculated using the Kaplan-Meier meth od. Nineteen of 393 patients (4.8%) with recurrent ovarian carcinoma w ere found to have recurrent tumor involving the vaginal apex. Nine pat ients (47%) were symptomatic from the vaginal recurrence: eight patien ts experienced vaginal bleeding, one had abnormal discharge, and one p atient had symptoms related to a rectovaginal fistula in addition to v aginal bleeding. Ten patients (53%) had an asymptomatic mass found on follow-up examination or at the time of second-look laparotomy. Fiftee n of 19 patients underwent surgical exploration: eight had recurrent d isease isolated to the vaginal apex, four had vaginal apex and pelvic disease, two had disease at the vaginal apex and in the upper abdomen, and one had disease present diffusely throughout the abdomen and pelv is in addition to the vaginal recurrence. Median time from original di agnosis to the diagnosis of a vaginal apical recurrence was 26 months. As of December, 1993, 15 of 19 patients had died of disease and four of 19 patients were alive with disease. The 1-year survival rate from the time of diagnosis of vaginal recurrence was 66% (95% confidence in terval: 43-88%); 56% for patients with vaginal bleeding and discharge and 78% for those with asymptomatic masses. Mean survival time was at least 19 months. Patients presenting with a vaginal apex recurrence of ovarian carcinoma should be treated aggressively, especially if sympt omatic, since they are likely to survive for at least 1 year following the recurrence.