Surgical treatment of recurrent ovarian cancer: report of 21 cases and a review of the literature

Cormio, Gennaro; Vagno, Giovanni Di; Cazzolla, Angela Pia; Bettocchi, Stefano; Gesu, Giuseppe Di; Loverro, Giuseppe; Selvaggi, Luigi

doi:10.1016/s0301-2115(99)00067-6

Cited by 35 publications

(32 citation statements)

References 9 publications

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“…In line with previous reports, removal of all visible tumours at SCS contributed to long-term survival (Figure 2). The rate of complete resection (59.1%) in our series was a little lower than the rates reported by Eisenkop et al (2000), Landoni et al (1998) and Cormio et al (1999). However, in Landoni's study, the subjects were restricted to those patients who were sensitive to first-line chemotherapy and chemotherapy before SCS.…”

Section: Discussioncontrasting

confidence: 58%

“…One reason is that some studies restricted the subjects for SCS to patients with isolated tumours or a solitary tumour (Cormio et al, 1999;Munkarah et al, 2001;Scarabelli et al, 2001). Another possible reason is that Eisenkop et al (2000) and Tay et al (2002) did not analyse the number of recurrent tumours as a factor influencing survival, although they pointed out that this factor may influence SCS outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Although only preoperative or intraoperative variables before starting SCS should be analysed for selection of the candidate, these variables have been analysed together with SCS outcome in most previous studies. In addition, the follow-up periods of living patients were rather short (the median or average follow-up periods were between 1 and 4 years) (Jänicke et al, 1992;Vaccarello et al, 1995;Cormio et al, 1999;Zang et al, 2000Zang et al, , 2004Munkarah et al, 2001;Scarabelli et al, 2001) in most of the previous reports.…”

mentioning

confidence: 99%

“…Recently, several investigators have reported the significant value of secondary cytoreductive surgery (SCS) in a subset of patients with recurrent ovarian cancer (Jänicke et al, 1992;Eisenkop et al, 1995Eisenkop et al, , 2000Vaccarello et al, 1995;Cormio et al, 1999;Zang et al, 2000Zang et al, , 2004Munkarah et al, 2001;Scarabelli et al, 2001;Tay et al, 2002). The value of complete resection at the time of SCS for highly selected patients is in consensus in these recent reports.…”

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Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection

et al. 2005

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The value of secondary cytoreductive surgery (SCS) for recurrent ovarian cancer is still controversial. The aim of this study was to clarify candidates for SCS. Between January 1987 and September 2000, we performed SCS in 44 patients with recurrent ovarian cancer, according to our selection criteria, disease-free interval (DFI) 46 months, performance status o3, no apparent multiple diseases, age o75years and no progressive disease during preoperative chemotherapy, if undertaken. The variables were investigated by univariate and multivariate analyses. Of 44 patients, 26 (59.1%) achieved complete removal of all visible tumours at SCS. Secondary cytoreductive surgery outcome, complete or incomplete resection, was significantly related to overall survival (P ¼ 0.0019). As for variables determined before SCS, DFI 412 months, no liver metastasis, solitary tumour and tumour size o6 cm were independently associated with favourable overall survival after recurrence in the multivariate analysis. Patients with three or all four variables (n ¼ 31) had significantly better survival compared with the other patients (n ¼ 13) (47 vs 20 months in median survival, Po0.0001). In these patients, fairly good median survival (40 months) was obtained even in patients with incomplete resection. Secondary cytoreductive surgery had a large impact on survival of patients with recurrent ovarian cancer when they had three or all of the above-mentioned four factors at recurrence. These patients should be considered as ideal candidates for SCS.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection

et al. 2005

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“…28 Subsequently, other definitions of residual disease have been shown to be associated with a significant survival benefit including 2 cm, 29-32 1 cm, 33-37 5 mm, [38][39][40] and no gross residual disease. [41][42][43][44][45][46][47][48][49][50][51][52] A recent meta-analysis of 40 studies on cytoreductive surgery in recurrent EOC included 2,019 patients. 53 The median diseasefree interval (DFI) was 20.2 months and median survival after recurrence was 30.3 months.…”

Section: Recurrent Diseasementioning

confidence: 99%

Maximal cytoreductive effort in epithelial ovarian cancer surgery

2010

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The surgical management of advanced epithelial ovarian cancer involves cytoreduction, or removal of grossly-evident tumor. Residual disease after surgical cytoreduction of ovarian cancer has been shown to be strongly associated with survival. The goal of surgery is "optimal" surgical cytoreduction, which is generally defined as residual disease of 1 cm or less. However, the designation of "optimal" surgical cytoreduction has evolved to include maximal surgical effort and no gross residual disease. In order to achieve this, more aggressive surgical procedures such as rectosigmoidectomy, diaphragm peritonectomy, partial liver resection, and video-assisted thoracic surgery are reported and increasingly utilized in the surgical management of advanced ovarian cancer. The role of maximal surgical effort also extends to the recurrent setting where the goal of surgery should be complete cytoreduction. Patient selection is important in identifying appropriate candidates for surgical cytoreduction in the recurrent setting. The purpose of this article is to review the role of maximum surgical effort in primary and recurrent ovarian cancer.

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Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

Salani

Santillan

Zahurak

et al. 2007

Cancer

132

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BACKGROUND.The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease.METHODS.Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival.RESULTS.Fifty‐five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis‐to‐recurrence interval was 32 months (range, 12–164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis‐to‐recurrence interval ≥18 months (median survival, 49 months vs 3 months; P < .01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P < .03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P < .01). Age, tumor grade, histology, CA‐125 level, ascites, and tumor size were not associated significantly with survival.CONCLUSIONS.The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis‐to‐recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months. Cancer 2007. © 2007 American Cancer Society.

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Surgical treatment of recurrent ovarian cancer: report of 21 cases and a review of the literature

Cited by 35 publications

References 9 publications

Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection

Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection

Maximal cytoreductive effort in epithelial ovarian cancer surgery

Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

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