Value of tertiary cytoreductive surgery in epithelial ovarian cancer: an international multicenter evaluation.
BACKGROUND
The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival.


METHODS
Retrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia.


RESULTS
We evaluated 406 patients (median age, 55 years; range, 16-80 years). Median time from first to second recurrence was 18 months (2-204 months). Median follow-up from TCS was 14 months (0-182 months), and median OS was 26 months (95 % CI, 19.62-32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5-56.4 months) versus 12 months (95 % CI 9.3-14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS.


CONCLUSIONS
In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC.
Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany. chfotopoulou@gmail.com
Christina
C
Fotopoulou
Rongyu
R
Zang
Murat
M
Gultekin
David
D
Cibula
Ali
A
Ayhan
Dongli
D
Liu
Rolf
R
Richter
Ioana
I
Braicu
Sven
S
Mahner
Philipp
P
Harter
Fabian
F
Trillsch
Sanjeev
S
Kumar
Michele
M
Peiretti
Sean C
SC
Dowdy
Angelo
A
Maggioni
Claes
C
Trope
Jalid
J
Sehouli
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