Quaternary and beyond cytoreduction: An updated and expanded analysis

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Ovarian Cancer Research

Background:

• Cytoreductive surgery is a cornerstone in managing advanced ovarian cancer.
• Further cytoreductive procedures beyond the third recurrence are rarely reported.

Purpose of the Study:

• To evaluate the clinicopathologic features and outcomes of patients undergoing quaternary, quinary, or senary cytoreductive surgery for ovarian cancer.
• To assess the safety and efficacy of extensive cytoreductive surgery in recurrent ovarian cancer.

Main Methods:

• Retrospective identification of patients who underwent quaternary or beyond cytoreduction for recurrent ovarian, fallopian tube, or primary peritoneal cancer.
• Kaplan-Meier survival analysis and Cox-proportional hazards regression were used to assess survival outcomes.
• Clinicopathologic data and surgical outcomes were analyzed.

Main Results:

• Twenty patients underwent 24 extensive cytoreductive surgeries (20 quaternary, 3 quinary, 1 senary).
• Complete gross resection was achieved in 85.0% of quaternary cytoreductions, with low-grade complications.
• Prolonged treatment-free interval and complete gross resection were associated with improved progression-free and disease-specific survival.

Conclusions:

• Quaternary cytoreductive surgery can be performed with acceptable morbidity and survival in carefully selected ovarian cancer patients.
• Patients benefiting most from quaternary surgery have a prolonged treatment-free interval and achieve complete gross resection.
• Quinary and senary surgeries demonstrated similar safety profiles to quaternary surgery.