title: Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer.
abstract: OBJECTIVE
  To evaluate the feasibility and associated survival outcome of secondary cytoreductive surgery in patients with isolated lymph node recurrence of epithelial ovarian cancer.
  
  
  METHODS
  Twenty-five patients with epithelial ovarian cancer who underwent secondary cytoreductive surgery for isolated lymph node recurrence were identified from tumor registry databases. Demographic, diagnostic, operative, pathologic, and follow-up data were abstracted retrospectively. Overall survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  The median age at time of primary surgery for ovarian cancer was 55 years; 72% of patients had FIGO III/IV disease, and all had high-grade tumors. All patients received platinum-based chemotherapy following primary surgery. The median time from completion of primary chemotherapy to nodal recurrence surgery was 16 months (range=6 to 40 months). The distribution of nodal involvement was pelvic=12% (n=3), para-aortic=60% (n=15), inguinal=20% (n=5), peri-cardiac=4% (n=1), and pelvic plus para-aortic=4% (n=1). The maximal nodal tumor diameter ranged from 1.5 cm to 14 cm, with a median of 3.0 cm. Optimal secondary cytoreductive surgery (residual disease </=1 cm) was achieved in 100% of patients. The median estimated intra-operative blood loss was 100 cc (range=10 cc to 600 cc). The length of hospitalization ranged from 2 days to 10 days, with a median of 4 days. There was no instance significant postoperative morbidity. At a median post-recurrence follow-up time of 19 months, 8 patients (32%) have died of the disease, 7 (28%) are alive with disease, and 10 (40%) patients are without evidence of disease. For the entire study population, the median post-recurrence OS after secondary cytoreduction of recurrent nodal disease was 37 months.
  
  
  CONCLUSIONS
  Complete optimal secondary cytoreductive surgery for recurrent epithelial ovarian cancer presenting as isolated node metastases is achievable in the majority of cases and is associated with a favorable long-term survival outcome.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Phipps #281, Baltimore, MD 21287-1281, USA. asantil1@jhmi.edu
authors.forename: Antonio
authors.initials: A
authors.lastname: Santillan
authors.forename: Amer K
authors.initials: AK
authors.lastname: Karam
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Li
authors.forename: Robert
authors.initials: R
authors.lastname: Giuntoli
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Ilana
authors.initials: I
authors.lastname: Cass
authors.forename: Beth Y
authors.initials: BY
authors.lastname: Karlan
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004847:Epithelial Cells / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*