title: Secondary cytoreductive surgery for localized intra-abdominal recurrences in epithelial ovarian cancer.
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer with an apparent solitary intra-abdominal focus.
  
  
  METHODS
  We conducted a retrospective review of patients with epithelial ovarian cancer who underwent secondary cytoreduction for recurrence at the University of Texas M. D. Anderson Cancer Center between 1985 and 1994. Eligible patients included those who had a laparotomy to resect a tumor that was apparently solitary. Cytoreductive surgery was defined as optimal if the diameter of the largest residual tumor was < or =2 cm and suboptimal if >2 cm.
  
  
  RESULTS
  Twenty-five patients met our eligibility criteria. Their mean age was 55 years (range, 35-73 years). The median time from primary diagnosis to recurrence was 37.6 months. Tumor was found to be confined to a solitary site in 15 patients (60%), to two sites in 6 (24%), and to three or more sites in 4 (16%). Surgical procedures included cytoreduction in 10 patients, intestinal resection in 8, splenectomy in 3, and limited biopsies in 4. Secondary cytoreduction was optimal in 18 of 25 patients (72%). The median postsecondary cytoreduction survival was 25.1 months for patients who had suboptimal secondary cytoreduction compared with 56.9 months for those who had optimal cytoreduction (P = 0.08).
  
  
  CONCLUSIONS
  Secondary cytoreductive surgery for recurrent ovarian cancer at an apparently solitary intra-abdominal site resulted in optimal residual tumor in a high proportion of patients. Although there was no survival advantage for patients whose tumor was optimally debulked, there was a trend toward improved survival. A large prospective randomized trial of secondary cytoreduction for recurrence is recommended.
authors.affiliation: Division of Gynecologic Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI 48201, USA. amunkara@med.wayne.edu
authors.forename: A
authors.initials: A
authors.lastname: Munkarah
authors.forename: C
authors.initials: C
authors.lastname: Levenback
authors.forename: J K
authors.initials: JK
authors.lastname: Wolf
authors.forename: D
authors.initials: D
authors.lastname: Bodurka-Bevers
authors.forename: G
authors.initials: G
authors.lastname: Tortolero-Luna
authors.forename: R T
authors.initials: RT
authors.lastname: Morris
authors.forename: D M
authors.initials: DM
authors.lastname: Gershenson
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000473:pathology / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome