Salvage Surgery for Localized Recurrent Ovarian Clear Cell Carcinoma: A Retrospective Case Series

Objectives: The aim of this study was to evaluate the clinical outcomes of salvage surgery for localized recurrent ovarian clear cell carcinoma (OCCC), a chemoresistant subtype with poor prognosis.

We retrospectively analyzed 75 patients who underwent primary surgery for OCCC between January 1996 and December 2022.

Twenty-two patients experienced recurrence after complete resection, of whom 10 met the institutional criteria for localized, resectable recurrence and underwent 17 salvage procedures. The clinical characteristics, surgical outcomes, and survival data were also reviewed. Progression-free survival (PFS) and post-recurrence survival (PRS) were analyzed using the Kaplan-Meier method.

Complete resection was achieved in all procedures. The median PFS after the first salvage surgery was 30 months and the median PRS was not reached. Four patients underwent a second and third salvage surgery, with several achieving long-term disease control or remaining disease-free. At the last follow-up, 7 of the 10 patients were alive without evidence of disease, including multiple survivors beyond five years. In contrast, the chemotherapy-only cohort (n = 12) showed a median PFS of 5 months and PRS of 10 months. No perioperative mortality occurred, and all complications were Clavien-Dindo grade II or lower.

Salvage surgery for localized recurrent OCCC can achieve durable disease control and long-term survival in carefully selected patients, particularly when complete resection is possible. Even in chemoresistant diseases, repeated cytoreductive surgery may offer meaningful benefits, supporting its role as a viable treatment option within a multidisciplinary framework.