Secondary cytoreductive surgery for localized intra-abdominal recurrences in epithelial ovarian cancer

Objective. The aim of this study was to evaluate the role of secondary cyto reductive surgery in patients with recurrent epithelial ovarian cancer with an apparent solitary intra-abdominal focus, Methods. We conducted a retrospective review of patients with epithelial ov arian cancer who underwent secondary cytoreduction for recurrence at the Un iversity of Texas M. D. Anderson Cancer Center between 1985 and 1994. Eligi ble patients included those who had a laparotomy to resect a tumor that was apparently solitary. Cytoreductive surgery was defined as optimal if the d iameter of the largest residual tumor was less than or equal to2 cm and sub optimal if >2 cm, Results. Twenty-five patients met our eligibility criteria. Their mean age was 55 years (range, 35-73 years). The median time from primary diagnosis t o recurrence was 37.6 months, Tumor was found to be confined to a solitary site in 15 patients (60%), to two sites in 6 (24%), and to three or more si tes in 4 (16%), Surgical procedures included cytoreduction in 10 patients, intestinal resection in 8, splenectomy in 3, and limited biopsies in 4. Sec ondary cytoreduction was optimal in 18 of 25 patients (72%). The median pos tsecondary cytoreduction survival was 25.1 months for patients who had subo ptimal secondary cytoreduction compared with 56.9 months for those who had optimal cytoreduction (P = 0.08). Conclusions. Secondary cytoreductive surgery for recurrent ovarian cancer a t an apparently solitary intra-abdominal site resulted in optimal residual tumor in a high proportion of patients. Although there was no survival adva ntage for patients whose tumor was optimally debulked, there was a trend to ward improved survival. A large prospective randomized trial of secondary c ytoreduction for recurrence is recommended. (C) 2001 Academic Press.