Role of Secondary Cytoreductive Surgery in Ovarian Cancer Relapse: Who Will Benefit? A Systematic Analysis of 240 Consecutive Patients

Background and Objectives: In contrast to primary ovarian cancer, the value of surgery in relapsed-OC (ROC) remains unclear We evaluated surgical and clinical outcome of secondary cytoreduction in ROC Methods: All consecutive ROC patients who underwent secondary tumor-debulking surgery were systematically analyzed as based on a validated intraoperative documentation tool Tumor dissemination pattern. operative and clinical outcome were evaluated Cox-regression analysis was performed to identify independent predictors of mortality Results: Between 09/2000 and 10/2008, 240 operations were evaluated. 184 patients (81 1%) were platinum-sensitive and 43 (20%) platinum-resistant 47 5% of the patients had ascites. while 85 8% presented a multi focal tumor dissemination pattern In 53 8% a complete tumor resection was achieved. in another 24 2%. postoperative tumor residuals were <1 cm In multivariate analysis, no tumor resection (FIR 7 6. 95% Cl 2 9 19 9). ascites >500 ml (HR 6 76. 95% Cl. 3 77-12 1). platinum resistance (HR 3 1. 95% Cl 1 26-7 7). and initial FIGO stage IV (HR 2 86. 95% CI I 16-7) were the most significant risk factors for mortality Median OS was 42 3 months (95% CI 24 37-60 2). 17 7 months (95% CI 12 27-23 13), and 7 7 months (95% CI 3 1-12 3) for patients with complete tumor resection, tumor residuals <= 1 and >1 cm. respectively (trend P-value <0001) Conclusions: Absence of ascites, platinum-sensitivity, initial FIGO stage