Tertiary cytoreduction in the setting of recurrent ovarian cancer (Review)

Ovarian cancer is the most lethal gynecological malignancy, with aggressive surgical debulking and adjuvant chemotherapy as the main treatment modalities. Optimal debulking during the primary surgery is significantly correlated with prolonged survival. As surgical techniques and chemotherapeutic agents improve, more patients with prolonged survival may face secondary and tertiary recurrences. The role of surgical debulking in secondary cytoreduction (SC) is not clearly defined and is based on retrospective series. The treatment of patients with primary or secondary recurrences generally consists of second-line chemotherapy, but may be performed on medically fit patients in certain circumstances. A limited number of studies concerning tertiary cytoreduction (TC) in cases of secondary recurrences have been published. In these studies, conventional prognostic factors for SC, including ascites, an advanced International Federation of Gynecology and Obstetrics (FIGO) stage and/or peritoneal carcinomatosis, did not apply to TC, but the post-operative residual tumor load was significant in determining the prognosis. A limited number of patients with completely-resectable tumors may have an opportunity for a maximal cytoreduction in these circumstances. TC appears to result in a favorable outcome and moderate complication rates. The surgery is an available option for patients with recurrence, in whom a complete tumor resection may be achieved.