CYTOREDUCTIVE SURGERY IN OVARIAN-CARCINOMA PATIENTS WITH A DOCUMENTEDPREVIOUSLY COMPLETE SURGICAL RESPONSE

Recurrent ovarian cancer after negative findings at second-look laparo tomy is common. A retrospective review of 57 patients who developed re current tumor after a negative second-look laparotomy was undertaken t o evaluate treatment efficacy and prognostic factors, All patients rec eived primary platinum-based chemotherapy. Recurrences occurred in the abdomen or pelvis (40 patients), lymph nodes (7), liver (4), lungs (3 ), and vagina (3), Recurrent disease was diagnosed at a mean interval of 20 months after second-look surgery. Of the 38 patients who underwe nt laparotomy for recurrence, 36 (95%) had >0.5 cm disease. After cyto reductive surgery 14 patients (37%) were left with minimal (<0.5 cm) r esidual disease. Intestinal resection or bypass was performed on 10/38 patients (26%) with one requiring a colostomy. There was no operative mortality and one complication (small bowel obstruction). Treatment a fter recurrence consisted of platinum-based chemotherapy (88%), with t he remaining patients receiving irradiation or hormonal therapy. At a mean follow-up from recurrence for the entire group of 20 months, 18/3 8 (47%) explored patients are alive, All 19 patients who were not expl ored died with a median survival time from recurrence of 9 months. Pat ients who underwent a laparotomy and patients with <0.5 cm residual di sease had a significant survival advantage (P < 0.0001). Initial stage , grade, disease-free interval, and disease found at laparotomy did no t influence survival. Recurrent ovarian carcinoma after platinum-based chemotherapy is associated with a grave prognosis when the patient is deemed inoperable or when distant metastasis are found. Patients with disease reduced to <0.5 cm showed a significant survival advantage. ( C) 1995 Academic Press, Inc.