title: Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma.
abstract: OBJECTIVE
  The aim of this prospective study was to evaluate the influence of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer.
  
  
  METHODS
  Between June 1993 and June 1999, 149 patients after primary treatment underwent secondary cytoreductive surgery: 69 (46.3%) had recurrence-free interval (RFI) 7-12 months, 59 (39.6%) RFI 13-24 months, and 21 (14.1%) RFI >24 months. Exclusion criteria included secondary cytoreduction during second-look laparotomy, interval cytoreduction, and palliative surgery in patients with intestinal obstruction or progressive disease.
  
  
  RESULTS
  The median follow-up was 27 months. According to multivariate analysis, RFI groups, prior chemotherapy combination, and residual tumor after secondary surgery were associated independently with overall survival. Residual tumor after secondary surgery was by far the most strongly predictive factor for patient's survival (hazard ratio (HR) 2.65; 95% confidence interval (CI) 1.43-4.92). The 2-year survival rates were 22.3, 62.9, and 22.7%, respectively, for patients with RFI 7-12, 13-24, and >24 months. The 5-year survival was 29% for patients with RFI 13-24 months. No patients with RFI 7-12 and >24 months outlived the 4-year estimate. Unexpectedly, RFI >24 months was not correlated significantly with overall survival. However, 17 patients (81%) with RFI >24 months were heavily treated with chemotherapy before secondary surgery.
  
  
  CONCLUSIONS
  Patients who have documented gross disease preoperatively should be selected for a secondary debulking operation; the entity of surgical effort would be modulated in relation to previous treatment.
authors.affiliation: Division of Gynecologic Oncology, Centro di Riferimento Oncologico di Aviano, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, Via Pedemontana Occidentale No. 12, Aviano (PN), 33081, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Scarabelli
authors.forename: A
authors.initials: A
authors.lastname: Gallo
authors.forename: A
authors.initials: A
authors.lastname: Carbone
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome