SECONDARY CYTOREDUCTIVE SURGERY FOR RECURRENT OVARIAN-CANCER - A PROSPECTIVE-STUDY

Background. The prognosis for patients with recurrent epithelial ovari an cancer is poor. Most are treated with salvage chemotherapy, The rol e of secondary cytoreductive surgery is controversial. Hence, this pro spective study was undertaken to determine the feasibility and benefit of secondary cytoreductive surgery before the administration of salva ge chemotherapy. Methods. Between 1990 and 1994, 36 patients with recu rrent epithelial ovarian cancer underwent secondary surgical cytoreduc tion, All had prior primary cytoreductive surgery, platin-based chemot herapy, and had relapsed at least 6 months after completion of primary treatment. The goal was the excision of all macroscopic disease befor e initiation of chemotherapy or radiation therapy. Statistical analysi s was undertaken to determine which clinical and pathologic variables influenced the feasibility of complete excision as well as morbidity, mortality, survival benefit, and quality of life resulting from second ary cytoreductive surgery. Results. Thirty (83.0%) patients had comple te surgical excisions. The probability of a complete excision was infl uenced by Gynecologic Oncology Group (GOG) performance status (0-2 vs. 3, P = 0.05) and size of largest tumor deposit (<10 cm vs. >10 cm, P = 0.03). Eleven (30.1%) patients experienced morbidity and 1 (2.8%) di ed postoperatively. Of 27 symptomatic patients with at least 3 months of follow-up, 26 (96.2%) had resolution or improvement of their sympto ms. Of 25 followed for at least 6 months postoperatively, 23 (92.0%) h ad a GOG performance status of 0 or 1. Survival was adversely influenc ed by the administration of salvage chemotherapy before surgery (P = 0 .02), a preoperative GOG performance status of 3 (P = 0.01), and a bri ef disease free interval after completion of primary treatment (P = 0. 01). The median survival was extended for patients completely resected before salvage chemotherapy or radiation, compared with those with ma croscopic residual disease remaining (43 vs. 5 months, P = 0.03). Conc lusions, Complete secondary cytoreductive surgery for recurrent epithe lial ovarian cancer is technically feasible and has an acceptable oper ative complication rate. Survival is significantly improved for patien ts having complete resection. Subsequent relief of symptoms and perfor mance status are excellent.