Impact of secondary cytoreductive surgery on survival of patients with advanced epithelial ovarian cancer

Aims: To investigate the impact on survival of secondary cytoreduction for advanced epithelial ovarian cancer and variables influencing redebulking su rgical outcome. Methods: Between 1986 and 1997, 106 patients who received secondary cytored uctive surgery and consequent second-line chemotherapy for stages III and I V epithelial ovarian cancer were retrospectively reviewed. The optimal resi dual disease cut-off was 1.0 cm. The Cox proportional regression model and logistic stepwise regression were used in statistical processing of the dat a. Results: The median age of the patients was 50 years (range, 26-77 years). Optimal secondary cytoreduction was achieved in 46 of 106 patients (43.4%). There was a significant difference in survival between patients who were o ptimally cytoreduced compared to those suboptimaly cytoreduced, with an est imated median survival in the optimal group of 20 months vs 8 months in the suboptimal group (chi (2)=42.03, P=0.0000). When factorized, patients had significant survival benefit from optimal secondary cytoreduction for recur rent disease and interval cytoreduction. Survival was adversely influenced by progression-free interval less than or equal to 12 months (P=0.0078), re sidual disease >1cm (P= 0.0001) and presence of refractory ascites (P= 0.00 01). The probability of successful redebulking surgery was affected by pres ence of refractory ascites (P=0.0023) in all 106 patients and by the ascite s (P=0.0072) and residual disease at initial operation in recurrent disease (P=0.0096). Conclusion: Secondary surgical cytoreduction significantly lengthened survi val for patients with recurrent epithelial ovarian cancer or those receivin g interval cytoreduction. Patients with refractory ascites, however, were n ot suitable for aggressive secondary surgery, and redebulking surgery for t hose with residual disease of >1.0 cm after primary operation should be con sidered prudently in recurrent disease. (C) 2000 Harcourt Publishers Ltd.