Surgery for recurrent epithelial ovarian cancer
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
- Eva Chalas, MD, FACOG, FACS
Eva Chalas, MD, FACOG, FACS
- Vice Chair, Department of Obstetrics and Gynecology
- Director, Division of Gynecologic Oncology
- Director, Clinical Cancer Services
- Winthrop University Hospital
- Professor, Department of Obstetrics, Gynecology and Reproductive Medicine
- Stony Brook University
- Fidel A Valea, MD
Fidel A Valea, MD
- Associate Professor
- Division of Gynecologic Oncology
- Duke University Medical Center
Surgical approaches to treatment of women with recurrent epithelial ovarian cancer (EOC) are generally palliative: to prolong survival and quality of life. These procedures will be reviewed here. Second line medical therapy 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".)
SECONDARY CYTOREDUCTIVE SURGERY
The majority of ovarian cancer recurrences are within the abdomen and thus potentially amenable to cytoreductive surgery. However, the benefit of secondary cytoreduction in women with a documented or suspected recurrence of EOC is unclear because of the lack of large, randomized trials examining this issue . Since early recurrences (ie, those with a short relapse-free interval) are often associated with a poor response to chemotherapy, the benefit of a repeat cytoreduction may be limited in this subgroup of women. (See "Medical treatment for relapsed epithelial ovarian, fallopian tubal, or peritoneal cancer: Platinum-resistant disease" and "Medical treatment for relapsed epithelial ovarian, fallopian tubal, or peritoneal cancer: Platinum-sensitive disease".)
Criteria — Based upon available data, secondary surgical cytoreduction is best considered only for those patients who have all of the following characteristics [2-7]:
- An extended progression-free interval of at least 12 months
- Potentially can be rendered free of all gross residual disease
- Response to first-line therapy
- Good performance status
- Locally recurrent EOC
Excision of all gross residual disease is the critical prognostic factor. Review of outcomes after secondary cytoreductive surgery showed survival of patients with optimal debulking (≤1 cm) was 16 to 61 months versus 8 to 27 months in those with suboptimal cytoreduction [8-11].
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