Evaluation of second cytoreductive surgery in the treatment of epithelial ovarian cancer

To evaluate the effectiveness of second cytoreductive surgery in the treatment of epithelial ovarian cancer. From January 1989 to June 1994, second cytoreductive surgery was carried out on 33 patients with epithelial ovarian cancer who either underwent unsatisfactory primary debulking operation or had recurrence. According to FIGO staging (1987), there were 5 patients in stage I, 2 in stage II, 25 in stage III, and 1 in stage IV. Pathological grading was G1 in 2 cases, G2 in 9, G3 in 19 and uncertain in 3. The 33 patients can be divided into 3 categories: I, nine patients who had unsatisfactory primary debulking operation with macroscopic residual > 2 cm, and 1-2 courses of postoperative chemotherapy; II, 15 patients who had 6-8 courses of cisplatin-based postoperative chemotherapy and in whom recurrence was diagnosed after complete response for at least 3 months; and III, 9 patients who had the same treatment as category II and survived without cancer clinically for more than 6 months, and in whom recurrence was diagnosed during second-look laparotomy. All patients had been followed up for at least two years (27-168 months) dated from the primary debulking operation. Fifteen cases had no macroscopic residuals (group A), 5 had residuals < 2 cm (group B), and 13 had residuals > 2 cm (group C). The medium survival time and two-year survival rate in groups A, B and C were 59.09, 20.6 and 8.29 months, and 93.3%, 20% and 7.69% respectively (P < 0.001, A vs C; P < 0.05, A vs B and B vs C). The results suggest that second cytoreductive surgery is of value, and the key to success is to eliminate any macroscopic residual focus, or at most, to leave only minimal residuals < 2 cm. It is suggested that well-targeted multiple-route chemotherapy with sufficient courses before second cytoreductive surgery is important to achieving better results.