The role of surgery in the second relapse of epithelial ovarian cancer. Selection criteria, morbidity and survival outcome.

BACKGROUND

The aim of this study was to investigate the benefit of cytoreductive surgery (CS) and palliative surgery (PS) because of bowel obstruction in the second relapse (SR) in epithelial ovarian cancer.

METHODS

A retrospective population-based study on recorded information from 490 consecutive patients treated at the Norwegian Radium Hospital during 1985-2001 for their SR. In all, 80 had surgery, 28 and 52 of which had their tertiary surgery (TS) and secondary surgery (SS), respectively and 410 were treated with chemotherapy or other therapy.

RESULTS

Median survival time (MST) was nine months for the last group. Complete optimal cytoreduction (COC) was achieved in 56% of the patients operated with CS. At SS and TS 33% and 38%, respectively, achieved COC. MST was 46 versus seven months for 0 versus > 2 cm residual disease. MST for the CS and PS was 31 versus five months, respectively. Twenty-eight percent with CS experienced complications versus 42% with PS including two deaths. On univariate analysis initial stage, residual tumor at first relapse, residual tumor at SR, treatment-free interval from primary treatment to first relapse (TFI 0-1), type of chemotherapy at SR, WHO performance status, ascites, elevated CA 125 values, number of lesions, localization of tumor and tumor size were found to be significant prognostic factors for survival in the surgery group.

CONCLUSIONS

The combination of COC, TFI 0-1 > or = 24 months, CA 125 < or = 35, < or = 3 tumor lesions and WHO 1 performance criteria identifies a group of patients with the best overall survival in SR.