title: Tertiary cytoreduction in patients with recurrent ovarian carcinoma.
abstract: OBJECTIVE
  The literature on the role of cytoreductive surgery beyond the secondary cytoreductive setting is limited. In this study, we reviewed the outcomes of patients with recurrent epithelial ovarian carcinoma who underwent tertiary cytoreduction.
  
  
  METHODS
  We performed a retrospective chart review of all patients with recurrent epithelial ovarian carcinoma who underwent tertiary cytoreduction at our institution from 1/1/90 to 12/31/02. Disease-specific survival (DSS) was calculated from the time of tertiary cytoreduction to last follow-up. Univariate and multivariate analyses were used to analyze outcomes and to identify potential prognostic factors.
  
  
  RESULTS
  A total of 26 patients were identified. The median follow-up after tertiary cytoreduction was 22.3 months (range, 0-71.7 months), with an overall median DSS of 33.4 months (95%CI, 20.4-46.4). On univariate analysis, treatment-free interval (TFI) before tertiary cytoreduction and residual disease after the procedure, as well as time to first recurrence, were found to be significant prognostic factors. Median DSS was 15 months for a TFI < or =12 months compared with 60.4 months for a TFI > 12 months (P = 0.002). The median DSS for patients with residual disease < or =0.5 cm was 36.3 months compared with 10.6 months for patients with residual disease >0.5 cm (P <0.0001). On multivariate analysis, TFI and residual disease after tertiary cytoreduction retained prognostic significance (P < 0.05 for both).
  
  
  CONCLUSIONS
  Further cytoreductive surgery may offer a survival benefit in patients who experience a recurrence after secondary cytoreduction. This benefit appears to be greatest in patients with a longer TFI (>12 months) and in whom an optimal (< or = 0.5 cm) cytoreduction can be achieved.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
authors.forename: Steven
authors.initials: S
authors.lastname: Kardos
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies