Surgery for Recurrent Ovarian Cancer

Abstract

Most patients with ovarian cancer (OC) have the epithelial subtype (EOC) and present with advanced stage disease. Despite improved surgical and medical management of primary disease, the majority of patients will develop recurrence and ultimately die of disease. The current surgical goal in primary EOC is complete surgical cytoreduction (CSC) as this significantly improves disease-specific survival and overall survival. CSC is a major independent prognostic factor in primary EOC. Recurrent ovarian cancer (ROC) can be diagnosed in the symptomatic or in the asymptomatic patient on clinical evidence, tumour marker results and/or imaging. There are data from cases series and retrospective series on the role of surgery in ROC but there is not yet level I evidence of secondary surgical cytoreduction improving overall survival. The published data emphasise that, as with primary disease, the surgical goal is CSC. In selecting patients for secondary cytoreductive surgery a number of predictive models have been proposed and tested. Patients with ROC who have undergone CSC have a better prognosis than those treated with chemotherapy alone or those in whom the surgical goal was not achieved. The counter-argument is that there is bias in the surgical reports — those patients not operated on chemotherapy alone, or who had incomplete cytoreduction and/or who had chemotherapy had less favourable disease- associated and patient-associated factors than those who had CSC. To address these concerns, there are currently three ongoing randomised controlled trials on surgery for ROC.