Recurrent ovarian carcinoma: is there a place for surgery?

The role of cytoreductive surgery is well established in patients with primary ovarian carcinoma. Minimal residual disease translates to improved response to adjuvant treatment and prolonged survival. For close clinical follow-up, different approaches may be helpful in detecting recurrent disease, including regular physical/pelvic examination, serial CA-125 levels, and imaging studies using computerized tomography, magnetic resonance imaging, or positron emission testing. At recurrence, those patients with a good performance status, a good response to primary therapy, and a macronodular tumor distribution pattern may be candidates for a secondary cytoreductive procedure. Data suggests that secondary cytoreduction is superior to chemotherapy alone in patients who have a significant disease-free interval (6 to 12 months). Survival after secondary cytoreduction is optimized with cytoreduction to microscopic disease, yet there is a recognized risk of surgical morbidity. Therefore, a strong relationship between the gynecologic oncology surgeon and the patient is key to obtaining appropriate informed consent and relaying appropriate outcome expectations.