Value of Tertiary Cytoreductive Surgery in Epithelial Ovarian Cancer: An International Multicenter Evaluation

Value of Tertiary Cytoreductive Surgery in Epithelial Ovarian Cancer: An International Multicenter Evaluation

Abstract

Background 

The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate
the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete
tumor resection and survival.

Methods 

Retrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United
States, and Asia.

Results 

We evaluated 406 patients (median age, 55 years; range, 16–80 years). Median time from first to second recurrence was 18 months
(2–204 months). Median follow-up from TCS was 14 months (0–182 months), and median OS was 26 months (95 % CI, 19.62–32.38 months).
Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5–56.4 months) versus 12 months (95 %
CI 9.3–14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %),
and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor
dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively.
Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis
to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing
interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly
affected OS.

Conclusions 

In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of
OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define
the value of TCS in EOC.