EVALUATION OF 2ND CYTOREDUCTIVE SURGERY IN THE TREATMENT OF EPITHELIAL OVARIAN-CANCER

Objective To evaluate the effectiveness of second cytoreductive surger y in the treatment of epithelial ovarian cancer. Methods From January 1989 to June 1994, second cytoreductive surgery was carried out on 33 patients with epithelial ovarian cancer who either underwent unsatisfa ctory primary debulking operation or had recurrence. According to FIGO staging (1987), there were 5 patients in stage I, 2 in stage II, 25 i n stage III, and 1 in stage IV. Pathological grading was G(1) in 2 cas es, G(2) in 9, G(3) in 19 and uncertain in 3. The 33 patients can be d ivided into 3 categories: I, nine patients who had unsatisfactory prim ary debulking operation with macroscopic residual > 2 cm, and 1-2 cour ses of postoperative chemotherapy; II, 15 patients who had 6-8 courses of cisplatin-based postoperative chemotherapy and in whom recurrence was diagnosed after complete response for at least 3 months; and III, 9 patients who had the same treatment as category II and survived with out cancer clinically for more than 6 months, and in whom recurrence w as diagnosed during second-look laparotomy. All patients had been foll owed up for at least two years (27-168 months) dated from the primary debulking operation. Results Fifteen cases had no macroscopic residual s (group A), 5 had residuals < 2 cm (group B), and 13 had residuals > 2 cm (group C). The medium survival time and two-year survival rate in groups A, B and C were 59.09, 20.6 and 8.29 months, and 93.3%, 20% an d 7.69% respectively (P < 0.001, A vs C; P < 0.05, A vs B and B vs C). Conclusions The results suggest that second cytoreductive surgery is of value, and the key to success is to eliminate any macroscopic resid ual focus, or at most, to leave only minimal residuals < 2 cm. It is s uggested that well-targeted multiple-route chemotherapy with sufficien t courses before second cytoreductive surgery is important to achievin g better results.