title: Tertiary Cytoreduction for Recurrent Epithelial Ovarian Cancer: a Multicenter Study in Turkey.
abstract: BACKGROUND
  The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC.
  
  
  METHODS
  Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05.
  
  
  RESULTS
  Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III-IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery . Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis.
  
  
  CONCLUSIONS
  Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul, Turkey E-mail : ilkerkahramanoglu@ hotmail.com.
authors.forename: Macit
authors.initials: M
authors.lastname: Arvas
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Salihoglu
authors.forename: Veysel
authors.initials: V
authors.lastname: Sal
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gungor
authors.forename: Hamdullah
authors.initials: H
authors.lastname: Sozen
authors.forename: Ilker
authors.initials: I
authors.lastname: Kahramanoglu
authors.forename: Samet
authors.initials: S
authors.lastname: Topuz
authors.forename: Fuat
authors.initials: F
authors.lastname: Demirkiran
authors.forename: Cem
authors.initials: C
authors.lastname: Iyibozkurt
authors.forename: Tugan
authors.initials: T
authors.lastname: Bese
authors.forename: Burcin Salman
authors.initials: BS
authors.lastname: Ozgu
authors.forename: Dogan
authors.initials: D
authors.lastname: Vatansever
authors.forename: Nedim
authors.initials: N
authors.lastname: Tokgozoglu
authors.forename: Sinan
authors.initials: S
authors.lastname: Berkman
authors.forename: Hasan
authors.initials: H
authors.lastname: Turan
authors.forename: Ergin
authors.initials: E
authors.lastname: Bengisu
authors.forename: Nigar
authors.initials: N
authors.lastname: Sofiyeva
authors.forename: Irem
authors.initials: I
authors.lastname: Demiral
authors.forename: Mutlu
authors.initials: M
authors.lastname: Meydanli
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate