title: Cytoreductive surgery in ovarian carcinoma patients with a documented previously complete surgical response.
abstract: Recurrent ovarian cancer after negative findings at second-look laparotomy is common. A retrospective review of 57 patients who developed recurrent tumor after a negative second-look laparotomy was undertaken to evaluate treatment efficacy and prognostic factors. All patients received primary platinum-based chemotherapy. Recurrences occurred in the abdomen or pelvis (40 patients), lymph nodes (7), liver (4), lungs (3), and vagina (3). Recurrent disease was diagnosed at a mean interval of 20 months after second-look surgery. Of the 38 patients who underwent laparotomy for recurrence, 36 (95%) had > 0.5 cm disease. After cytoreductive surgery 14 patients (37%) were left with minimal (< 0.5 cm) residual disease. Intestinal resection or bypass was performed on 10/38 patients (26%) with one requiring a colostomy. There was no operative mortality and one complication (small bowel obstruction). Treatment after recurrence consisted of platinum-based chemotherapy (88%), with the remaining patients receiving irradiation or hormonal therapy. At a mean follow-up from recurrence for the entire group of 20 months, 18/38 (47%) explored patients are alive. All 19 patients who were not explored died with a median survival time from recurrence of 9 months. Patients who underwent a laparotomy and patients with < 0.5 cm residual disease had a significant survival advantage (P < 0.0001). Initial stage, grade, disease-free interval, and disease found at laparotomy did not influence survival. Recurrent ovarian carcinoma after platinum-based chemotherapy is associated with a grave prognosis when the patient is deemed inoperable or when distant metastasis are found. Patients with disease reduced to < 0.5 cm showed a significant survival advantage.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: L
authors.initials: L
authors.lastname: Vaccarello
authors.forename: S C
authors.initials: SC
authors.lastname: Rubin
authors.forename: V
authors.initials: V
authors.lastname: Vlamis
authors.forename: G
authors.initials: G
authors.lastname: Wong
authors.forename: W B
authors.initials: WB
authors.lastname: Jones
authors.forename: J L
authors.initials: JL
authors.lastname: Lewis
authors.forename: W J
authors.initials: WJ
authors.lastname: Hoskins
mesh_terms: D000008:Abdominal Neoplasms / Q000556:secondary; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000556:secondary; D010984:Platinum / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D010984:Platinum