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Cancer of the ovary, fallopian tube, and peritoneum: Surgery for recurrent cancer

Dennis S Chi, MD
Karin K Shih, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Ovarian cancer is the second most common gynecologic malignancy and the most common cause of gynecologic cancer death in the United States. (See "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Epidemiology and risk factors", section on 'Epidemiology'.)

The majority of ovarian cancer patients experience recurrence of disease [1]. The pattern of ovarian cancer recurrence varies from isolated nodal disease, to isolated peritoneal disease, to peritoneal carcinomatosis. Extra-abdominal sites of recurrence are not common with recurrent ovarian cancer.

Most patients with recurrent ovarian cancer are treated with chemotherapy alone. Surgical treatment is reserved for a select group of patients, and currently there are several clinical trials underway to evaluate if secondary cytoreduction improves survival.

Surgery for recurrent ovarian cancer is reviewed here. Medical therapy for recurrent ovarian cancer and initial surgical therapy are discussed separately. (See "Medical treatment for relapsed epithelial ovarian, fallopian tubal, or peritoneal cancer: Platinum-resistant disease" and "Cancer of the ovary, fallopian tube, and peritoneum: Staging and initial surgical management".)


Surveillance of ovarian cancer patients includes physical examination and serum cancer antigen 125 (CA 125), or other tumor markers if initially elevated. Imaging studies are performed as clinically indicated. Recurrence of ovarian cancer most commonly occurs in the peritoneal cavity (abdomen or pelvis), or in the thoracic cavity.

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Literature review current through: Dec 2017. | This topic last updated: Dec 20, 2016.
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  1. Suh DH, Kim HS, Chang SJ, Bristow RE. Surgical management of recurrent ovarian cancer. Gynecol Oncol 2016; 142:357.
  2. Michielsen KL, Vergote I, Dresen R, et al. Whole-body diffusion-weighted magnetic resonance imaging in the diagnosis of recurrent ovarian cancer: a clinical feasibility study. Br J Radiol 2016; 89:20160468.
  3. Chi DS, McCaughty K, Diaz JP, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 2006; 106:1933.
  4. Eisenkop SM, Friedman RL, Spirtos NM. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 2000; 88:144.
  5. Gadducci A, Iacconi P, Cosio S, et al. Complete salvage surgical cytoreduction improves further survival of patients with late recurrent ovarian cancer. Gynecol Oncol 2000; 79:344.
  6. Eisenkop SM, Friedman RL, Wang HJ. Secondary cytoreductive surgery for recurrent ovarian cancer. A prospective study. Cancer 1995; 76:1606.
  7. Cormio G, di Vagno G, Cazzolla A, et al. Surgical treatment of recurrent ovarian cancer: report of 21 cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol 1999; 86:185.
  8. Scarabelli C, Gallo A, Carbone A. Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol 2001; 83:504.
  9. Tay EH, Grant PT, Gebski V, Hacker NF. Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Obstet Gynecol 2002; 99:1008.
  10. Gronlund B, Lundvall L, Christensen IJ, et al. Surgical cytoreduction in recurrent ovarian carcinoma in patients with complete response to paclitaxel-platinum. Eur J Surg Oncol 2005; 31:67.
  11. Onda T, Yoshikawa H, Yasugi T, et al. Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection. Br J Cancer 2005; 92:1026.
  12. Benedetti Panici P, De Vivo A, Bellati F, et al. Secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer. Ann Surg Oncol 2007; 14:1136.
  13. Salani R, Santillan A, Zahurak ML, et al. Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: analysis of prognostic factors and survival outcome. Cancer 2007; 109:685.
  14. Oksefjell H, Sandstad B, Tropé C. The role of secondary cytoreduction in the management of the first relapse in epithelial ovarian cancer. Ann Oncol 2009; 20:286.
  15. Tian WJ, Jiang R, Cheng X, et al. Surgery in recurrent epithelial ovarian cancer: benefits on Survival for patients with residual disease of 0.1-1 cm after secondary cytoreduction. J Surg Oncol 2010; 101:244.
  16. Petrillo M, Fagotti A, Ferrandina G, et al. Ovarian cancer patients with localized relapse: clinical outcome and prognostic factors. Gynecol Oncol 2013; 131:36.
  17. Tian WJ, Chi DS, Sehouli J, et al. A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: an evidence-based proposal for patient selection. Ann Surg Oncol 2012; 19:597.
  18. Zang RY, Harter P, Chi DS, et al. Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort. Br J Cancer 2011; 105:890.
  19. Harter P, du Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 2006; 13:1702.
  20. Roh HJ, Kim DY, Joo WD, et al. Hepatic resection as part of secondary cytoreductive surgery for recurrent ovarian cancer involving the liver. Arch Gynecol Obstet 2011; 284:1223.
  21. Yoon SS, Jarnagin WR, Fong Y, et al. Resection of recurrent ovarian or fallopian tube carcinoma involving the liver. Gynecol Oncol 2003; 91:383.
  22. Merideth MA, Cliby WA, Keeney GL, et al. Hepatic resection for metachronous metastases from ovarian carcinoma. Gynecol Oncol 2003; 89:16.
  23. Gemignani ML, Chi DS, Gurin CC, et al. Splenectomy in recurrent epithelial ovarian cancer. Gynecol Oncol 1999; 72:407.
  24. Manci N, Bellati F, Muzii L, et al. Splenectomy during secondary cytoreduction for ovarian cancer disease recurrence: surgical and survival data. Ann Surg Oncol 2006; 13:1717.
  25. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol 2009; 112:265.
  26. Al Rawahi T, Lopes AD, Bristow RE, et al. Surgical cytoreduction for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev 2013; :CD008765.
  27. Zang RY, Zhang ZY, Li ZT, et al. Effect of cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer. J Surg Oncol 2000; 75:24.
  28. Bickell NA, Egorova N, Prasad-Hayes M, et al. Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer. Am J Clin Oncol 2016.
  29. https://clinicaltrials.gov/ct2/show/NCT01166737?term=desktop&rank=2 (Accessed on December 12, 2016).
  30. https://clinicaltrials.gov/ct2/show/NCT00565851?term=GOG-0213&rank=1 (Accessed on December 12, 2016).
  31. van de Laar R, Zusterzeel PL, Van Gorp T, et al. Cytoreductive surgery followed by chemotherapy versus chemotherapy alone for recurrent platinum-sensitive epithelial ovarian cancer (SOCceR trial): a multicenter randomised controlled study. BMC Cancer 2014; 14:22.
  32. Plotti F, Scaletta G, Aloisi A, et al. Quality of Life in Platinum-Sensitive Recurrent Ovarian Cancer: Chemotherapy Versus Surgery Plus Chemotherapy. Ann Surg Oncol 2015; 22:2387.
  33. Chi DS, Phaëton R, Miner TJ, et al. A prospective outcomes analysis of palliative procedures performed for malignant intestinal obstruction due to recurrent ovarian cancer. Oncologist 2009; 14:835.
  34. Pothuri B, Vaidya A, Aghajanian C, et al. Palliative surgery for bowel obstruction in recurrent ovarian cancer:an updated series. Gynecol Oncol 2003; 89:306.
  35. Pothuri B, Meyer L, Gerardi M, et al. Reoperation for palliation of recurrent malignant bowel obstruction in ovarian carcinoma. Gynecol Oncol 2004; 95:193.
  36. Kolomainen DF, Daponte A, Barton DP, et al. Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol 2012; 125:31.
  37. Kucukmetin A, Naik R, Galaal K, et al. Palliative surgery versus medical management for bowel obstruction in ovarian cancer. Cochrane Database Syst Rev 2010; :CD007792.
  38. Mangili G, Aletti G, Frigerio L, et al. Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis. Int J Gynecol Cancer 2005; 15:830.
  39. Shih KK, Chi DS, Barakat RR, Leitao MM Jr. Tertiary cytoreduction in patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer: an updated series. Gynecol Oncol 2010; 117:330.
  40. Fotopoulou C, Richter R, Braicu IE, et al. Clinical outcome of tertiary surgical cytoreduction in patients with recurrent epithelial ovarian cancer. Ann Surg Oncol 2011; 18:49.
  41. Fotopoulou C, Zang R, Gultekin M, et al. Value of tertiary cytoreductive surgery in epithelial ovarian cancer: an international multicenter evaluation. Ann Surg Oncol 2013; 20:1348.
  42. Shih KK, Chi DS, Barakat RR, Leitao MM Jr. Beyond tertiary cytoreduction in patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. Gynecol Oncol 2010; 116:364.
  43. Fotopoulou C, Savvatis K, Kosian P, et al. Quaternary cytoreductive surgery in ovarian cancer: does surgical effort still matter? Br J Cancer 2013; 108:32.