title: Secondary cytoreductive surgery for isolated lymph node recurrence of epithelial ovarian cancer: a multicenter study.
abstract: BACKGROUND
  Chemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes.
  
  
  METHODS
  We conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected.
  
  
  RESULTS
  Seventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%.
  
  
  CONCLUSIONS
  Secondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome.
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: a.ferrero@katamail.com.
authors.forename: A
authors.initials: A
authors.lastname: Ferrero
authors.affiliation: Department of Gynecological Oncology, National Cancer Institute of Milan, Via Giacomo Venezian, 1, 20133 Milano, Italy. Electronic address: antonino.ditto@istitutotumori.mi.it.
authors.forename: A
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Department of Gynecological Oncology, Comprehensive Cancer Centre of Aviano, Via Franco Gallini, 2, 33081 Aviano, PN, Italy. Electronic address: giorgio.giorda@tin.it.
authors.forename: G
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Azienda Ospedaliero Universitaria Pisana, Via Roma, 67, 56100 Pisa, Italy. Electronic address: a.gadducci@med.unipi.it.
authors.forename: A
authors.initials: A
authors.lastname: Gadducci
authors.affiliation: Department of Gynecological Oncology, National Cancer Institute of Napoli, Via Mariano Semmola, 80131 Napoli, Italy. Electronic address: oncogin03@yahoo.it.
authors.forename: S
authors.initials: S
authors.lastname: Greggi
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: albertodaniele@hotmail.it.
authors.forename: A
authors.initials: A
authors.lastname: Daniele
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: lfuso@mauriziano.it.
authors.forename: L
authors.initials: L
authors.lastname: Fuso
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: ucciopan@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Panuccio
authors.affiliation: Department of Gynecological Oncology, National Cancer Institute of Napoli, Via Mariano Semmola, 80131 Napoli, Italy. Electronic address: oncogin03@yahoo.it.
authors.forename: C
authors.initials: C
authors.lastname: Scaffa
authors.affiliation: Department of Gynecological Oncology, National Cancer Institute of Milan, Via Giacomo Venezian, 1, 20133 Milano, Italy. Electronic address: francesco.raspagliesi@istitutotumori.mi.it.
authors.forename: F
authors.initials: F
authors.lastname: Raspagliesi
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: piero.sismondi@unito.it.
authors.forename: P
authors.initials: P
authors.lastname: Sismondi
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: nicoletta.biglia@unito.it.
authors.forename: N
authors.initials: N
authors.lastname: Biglia
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D010052:Ovariectomy / Q000379:methods; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Epithelial ovarian cancer; Isolated lymph node recurrence; Secondary cytoreductive surgery