[Secondary cytoreductions in the treatment of ovarian cancers]

The aim of this study was to investigate the potential benefit of secondary cytoreductive surgery for recurrent ovarian cancer.

Between 1980 and 1993, 85 patients (11 stage Ic, 4 stage IIc, 70 stage III) with an epithelial ovarian cancer were treated after initial surgery with an intraperitoneal and intravenous Cis Platin-based immunochemotherapy. Twenty patients of the 41 who relapsed underwent secondary cytoreductive surgery.

Complete resection was achieved in 13 patients (65%) and was optimal with a < 0.5 cm residual disease left in one case. One patient died postoperatively. Surgery was suboptimal for six patients (30%). At a mean follow-up from recurrence of more than 54 months for the surviving patients, five of the 20 reoperated are still alive. All 21 patients who were not reoperated died with a median survival time from recurrence of eight months (10.5 months for the patients who refused to be reoperated and seven months for the patients rejected by the surgeons) against 29 for the 20 reoperated patients (P < 0.004).

This series is too small to enable us to draw definitive conclusions. Nevertheless, our results seem to suggest the interest of secondary cytoreductive surgery. Indeed, only reoperated patients, above all if surgery was complete or at least optimal, have a chance of long survival. In our opinion, secondary surgical procedure should be proposed to relapsing patients to enhance efficacy of rescue chemotherapy, which is of limited value in bulky tumors.