Discussion On The Role Of Secondary Cytoreductive Surgery For Recurrent Ovarian Carcinoma.

Objective : The aim of this study was to assess the survival benefit of secondary cytoreductive surgery in patients with recurrent ovarian carcinoma and to investigate the variables influencing rebulking surgery outcome and clinical value.Methods: The clinical datas of patients with recurrent ovarian carcinoma from January 1997 to December 2006 in the general hospital of the People's Liberated Army were retrospectively analyzed regarding patient demographics, surgical management, preoperative evaluation, perioperative complications, and oncologic outcome. They were divided into four groups firstly by the identity of recurrent lesion : group A , single lesion ; B , disseminated lesion ; C , intestinal obstruction ; D , palliative surgery and the cases with regard to its macroscopic residual disease ,complications of operation ,cases with complete remission and partial remission ,postoperation survival time and disease-free interval were reviewed.Results: Fifty-six patients met eligibility criteria. Recytoreductive surgery for patients with isolated recurrent tumor were optimal.For those diagnosed as local lesion preoperatively ,61 % of thsee cases were found to have disseminated diseases postioerativelyl. Sixty-five percents of these cases recieved optimal RCRS ,but their prognosis were not as well as those with real isolated leasion(response rate : 36 % vs 67 %) . Preoperative factors that correlated with improved survival were disease-free interval of greater than 12 months (p<0.05) and residual disease after primary surgery of <2 cm (p<0.05). Optimal resection to <2 cm residual disease was achieved in 32 of patients who had secondary cytoreduction. Small bowel and colon resection for cytoreduction occurred in 52.63% of patients.Operative complications occurred in 33.91% and postoperative complications occurred in 21.43% of patients. The median survival of patients who were optimally cytoreduced to <2 cm was 39.6 months compared to 20.4 months for patients with residual disease>or=2 cm (p<0.05). Operative factors that were evaluated and did not significantly effect survival were location of recurrence, presence of ascites, and extent of recurrence.Conclusions: Re-cytoreductive surgery should be considered in patients with isolated recurrent ovarian cancer. Secondary surgical cytoreduction surgery significantly lengthened survival for patients with recurrent ovarian cancer , while it's important to perform the secondary cytoreductive surgeries considering patients' general conditions,previous treatments,tumor-free survival,refractory ascites. In order to avoid great damages to patients, operations should be carefully performed.