[How to increase the optimal rate of secondary cytoreductive surgery in recurrent epithelial ovarian cancer].

BACKGROUND & OBJECTIVE: Optimal secondary cytoreduction is of prognostic importance for recurrent epithelial ovarian cancer. To increase the optimal rate of secondary cytoreductive surgery in these patients is helpful for improving the prognosis of recurrent epithelial ovarian cancer patients. In this retrospective study, we investigated how to increase the optimal rate of secondary cytoreductive surgery in recurrent epithelial ovarian cancer patients.

METHODS

The clinical data of 54 patients with recurrent epithelial ovarian cancer were analyzed retrospectively, who received secondary cytoreductive surgery during March 1 1997 to March 31 2003 in Cancer Center, Sun Yat-sen University. Nineteen patients had tumors only in pelvis, and 35 patients both in pelvis and abdomen. Single tumor was found in 16 patients and multiple tumors in 38 patients. Thirty-eight patients had ascites and 16 patients no ascites. Preoperative chemotherapy was given to 20 cases, and responses were observed in 12 patients and no response in 8. Multivariate logistic regression was carried out to investigate the relationship of residual diseases of secondary cytoreduction with age, time to recurrence, recurrent sites, ascites, and preoperative salvage chemotherapy.

RESULTS

Optimal surgical cytoreduction was obtained in 81.5% (44/54) of the patients, with no macroscopic residual diseases in 53.7% (29/54) and residual diseases <or=2 cm in 27.8% (15/54). Logistic regression showed that recurrent sites and ascites were the significant factors for residual diseases after secondary cytoreductive surrey (both P <or= 0.05). Optimal cytoreduction was obtained in 100% (12/12) of the patients whose salvage chemotherapy before secondary cytoreduction was effective and in 37.5% (3/8) cases whose chemotherapy before secondary cytoreduction was ineffective (P<or=0.05, Chi(2) test). Complicated surgical procedures involving gastrointestinal tract, urinary tract, liver or spleen were carried out in 40.7% (22/54) of the patients. Post-operation complications occurred in 16.6% (9/54) and post-operation death rate was 1.9% (1/54).

CONCLUSION

It could be helpful for obtaining optimal secondary cytoreduction and avoiding helpless laparotomy to select patients properly according to the border of recurrent tumor, recurrent site, with or without ascites and the response of salvage chemotherapy before secondary cytoreduction and to do careful preoperative preparations.