title: The role of secondary cytoreduction in low-grade serous ovarian cancer or peritoneal cancer.
abstract: OBJECTIVE
  We sought to determine the benefit of secondary cytoreductive surgery (SCRS) in patients with low-grade serous ovarian or peritoneal carcinoma, and whether cytoreduction to no gross residual disease affects survival.
  
  
  METHODS
  A single institution retrospective chart review was conducted in patients with recurrent low-grade serous carcinoma who underwent SCRS between 1995 and 2012. Data including demographics, survival, chemotherapy, disease characteristics at the time of surgery, residual disease, and operative complications were collected. Overall survival (OS) and progression-free survival (PFS) were calculated. Kaplan-Meier and log-rank tests were used to examine survival outcomes.
  
  
  RESULTS
  Forty-one patients met inclusion criteria. The median time between primary tumor debulking and SCRS was 33.2 months. Of 41 eligible patients who underwent SCRS, 32 (78%) had gross residual disease at the completion of secondary surgery. The median PFS for patients with no gross residual disease after SCRS was 60.3 months, compared to 10.7 months for patients with gross residual disease (p = 0.008). Median OS from diagnosis for patients with no gross residual disease after SCRS was 167.5 months compared to 88.9 months (p = 0.10). Median OS from the time of SCRS for patients with no gross residual disease was 93.6 months compared to 45.8 months (p = 0.04). Complications occurred in 61% of patients after SCRS; there were no deaths directly attributable to surgery.
  
  
  CONCLUSIONS
  Our results suggest a benefit to SCRS in patients with recurrent low-grade serous carcinoma. Efforts to maximally cytoreduce patients should be made as patients with no gross residual disease had a better PFS and a trend toward better OS.
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Crane
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Anais
authors.initials: A
authors.lastname: Malpica
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: dgershen@mdanderson.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Gershenson
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Low-grade serous ovarian cancer; Optimal cytoreduction; Secondary cytoreduction