The role of secondary cytoreductive surgery in epithelial ovarian malignancies

The benefit of aggressive primary cytoreductive surgery in the management of patients with advanced epithelial ovarian cancer has been confirmed. The value of secondary cytoreductive surgery, however, is less clear. This approach is being studied in four categories of patients: (1) those clinically free of disease after a planned regimen of first-line chemotherapy who are found to have macroscopic tumor at second-look laparotomy; (2) patients found to have bulky, unresectable tumor at initial surgery and who undergo interval cytoreduction as part of a planned chemosurgical treatment approach; (3) those with recurrent disease after a prolonged disease-free interval; and (4) patients who progress on first-line therapy. This article reviews the technical success rates, complications, and survival in patients undergoing these secondary cytoreductive procedures.