UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Surgery for recurrent epithelial ovarian cancer

Authors
William J Mann, Jr, MD
Eva Chalas, MD, FACOG, FACS
Fidel A Valea, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

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 [1]. 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].

      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Oct 15 00:00:00 GMT+00:00 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Park JY, Eom JM, Kim DY, et al. Secondary cytoreductive surgery in the management of platinum-sensitive recurrent epithelial ovarian cancer. J Surg Oncol 2010; 101:418.
  2. Munkarah AR, Coleman RL. Critical evaluation of secondary cytoreduction in recurrent ovarian cancer. Gynecol Oncol 2004; 95:273.
  3. Güngör M, Ortaç F, Arvas M, et al. The role of secondary cytoreductive surgery for recurrent ovarian cancer. Gynecol Oncol 2005; 97:74.
  4. 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.
  5. Berek JS, Bertelsen K, du Bois A, et al. Advanced epithelial ovarian cancer: 1998 consensus statements. Ann Oncol 1999; 10 Suppl 1:87.
  6. 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.
  7. 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.
  8. Tebes SJ, Sayer RA, Palmer JM, et al. Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol 2007; 106:482.
  9. 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.
  10. Santillan A, Karam AK, Li AJ, et al. Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer. Gynecol Oncol 2007; 104:686.
  11. 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.
  12. 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.
  13. Cho SM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol 2002; 179:391.
  14. Yen RF, Sun SS, Shen YY, et al. Whole body positron emission tomography with 18F-fluoro-2-deoxyglucose for the detection of recurrent ovarian cancer. Anticancer Res 2001; 21:3691.
  15. Bristow RE, del Carmen MG, Pannu HK, et al. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol 2003; 90:519.
  16. Makhija S, Howden N, Edwards R, et al. Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review. Gynecol Oncol 2002; 85:53.
  17. Thrall MM, DeLoia JA, Gallion H, Avril N. Clinical use of combined positron emission tomography and computed tomography (FDG-PET/CT) in recurrent ovarian cancer. Gynecol Oncol 2007; 105:17.
  18. Soussan M, Wartski M, Cherel P, et al. Impact of FDG PET-CT imaging on the decision making in the biologic suspicion of ovarian carcinoma recurrence. Gynecol Oncol 2008; 108:160.
  19. Yoon SS, Jarnagin WR, Fong Y, et al. Resection of recurrent ovarian or fallopian tube carcinoma involving the liver. Gynecol Oncol 2003; 91:383.
  20. Merideth MA, Cliby WA, Keeney GL, et al. Hepatic resection for metachronous metastases from ovarian carcinoma. Gynecol Oncol 2003; 89:16.
  21. Adam R, Chiche L, Aloia T, et al. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann Surg 2006; 244:524.
  22. Rose PG, Piver MS, Tsukada Y, Lau TS. Metastatic patterns in histologic variants of ovarian cancer. An autopsy study. Cancer 1989; 64:1508.
  23. Feuer DJ, Broadley KE, Shepherd JH, Barton DP. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev 2000; :CD002764.
  24. Chalas E, Mann WJ Jr, Westermann CP, Patsner B. Morbidity and mortality of stapled anastomoses on a gynecologic oncology service: a retrospective review. Gynecol Oncol 1990; 37:82.
  25. Coukos G, Rubin SC. Surgical management of epithelial ovarian cancer. Oncology Spectrums 2001; 2:350.
  26. 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.
  27. Fink AS, Hutter MM, Campbell DC Jr, et al. Comparison of risk-adjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: general surgical operations in women. J Am Coll Surg 2007; 204:1127.
  28. Thigpen T, Brady MF, Omura GA, et al. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer 1993; 71:606.
  29. Tamussino KF, Lim PC, Webb MJ, et al. Gastrointestinal surgery in patients with ovarian cancer. Gynecol Oncol 2001; 80:79.
  30. Jong P, Sturgeon J, Jamieson CG. Benefit of palliative surgery for bowel obstruction in advanced ovarian cancer. Can J Surg 1995; 38:454.
  31. Pothuri B, Montemarano M, Gerardi M, et al. Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma. Gynecol Oncol 2005; 96:330.
  32. Leitao MM Jr, Kardos S, Barakat RR, Chi DS. Tertiary cytoreduction in patients with recurrent ovarian carcinoma. Gynecol Oncol 2004; 95:181.
  33. Karam AK, Santillan A, Bristow RE, et al. Tertiary cytoreductive surgery in recurrent ovarian cancer: selection criteria and survival outcome. Gynecol Oncol 2007; 104:377.
  34. 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.
  35. 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.