The survival impact and morbidity of secondary, tertiarty and quertarnary surgery for recurrent epithelial ovarian carsinoma

Objective:The aim of this study is to evaluate the survival impact and morbidity of secondary, tertiary and quarternary cytoreduction for epithelial ovarian carcinoma. Materials and Methods: Total of 349 invasive epithelial ovarian carcinoma patients who underwent secondary cytoreduction at Baskent University Hospital between 1/2/2007 and 1/5/2016 included in this study and the data of these patients' evaluted retrospectively after obtaining Research Ethics Committees' permission. The primary surgery of these patients was performed in our instute or at another hospital whereas patients who were suboptimally debulked at another hospital underwent complete debulking surgery. Afterwards 155 of the patients underwent tertiary cytoreduction while 55 of them underwent querternary cytoreduction. The role of optimal cytoreduction, progression free survival, platinum sensitivity, the site and type of recurrence (isolated, mulitple, carcinomatous), grade, stage and the level of serum cancer antigen (CA 125) was evaluated. Clinical and pathological data of the patients' were obtained from medical records or via phone calls. All the data analyzed by SPSS version 22 and survival times was obtained by using Kaplan-Meier and logistic regression model. Findings: The mean age of the patients was 52±11,6 years and the median follow up time was 111±10,3 months.Total of 342 patients underwent optimal secondary cytoreduction whereas the other 7 patients underwent suboptimal (>1 cm residual tumor) cytoreduction. The overall survival times were 36.6 vs. 15.3 months, respectively (p<0.001). Progression free survival, platinum sensitivity, the size of the recurrent tumor and the site of metastasis was found to be significant prognostic factors. In tertiary cytoreduction group, 139 of the patients were optimally debulked whereas 16 of the patients underwent suboptimal debulking (> 1cm residual tumor) and overall survival times were 22.2 vs. 6.4 months, respectively. The factors that had a significant prognostic role for secondary cytoreduction were also found significant for survival in tertiary cytoreduction group. Additionally, histologic type had a role in this group while it did not have a significant role in secondary cytoreduction group. In querternary cytoreduction group, 45 of the patients were optimally debulked whereas 10 of the patients underwent suboptimal debulking (> 1cm residual tumor) and overall survival times were 29.1 vs. 10.5 months, respectively. Progression free survival, platinum sensitivity, the site of metastasis and the histologic type was found to be significant prognostic factors. When compared to secondary and tertiart cytoreduction groups, the size of the recurrent tumor had lost its importance. Age (<65 vs <65), stage, grade, the level of CA 125, and the number of chemotherapy cycles had not have a role on prognosis. The morbidity rates of primary, secondary, tertiary and querternary surgery was 4.8%, 9.1%, 15.3% and 9%, respectively. Results: This study showed that secondary, tertiary and querternary surgery have a survival advantage when performed effectively and there is no residual tumor left. Progression free survival, the extent of the tumor, platinum sensitivity and the histologic type are important prognostic factors and they should be considered for the patient selection. The rates of morbidity is the same as the literature, in an acceptable range. Well designed retrospective and prospective studies must be conducted to improve the results of this study.