Role of secondary cytoreduction in recurrent ovarian cancer

The majority of ovarian cancer patients will recur despite aggressive initial debulking surgery followed by platinum- and taxane-based chemotherapy. At present, there is no standard of care for management of these patients. Secondary cytoreductive surgery may be offered to patients with disease recurrence after a disease-free interval of 6-12 months, during which time they demonstrate a complete response to primary therapy and have no evidence of disease. The key is to be able to accurately predict preoperatively which patients have the greatest likelihood of being completely cytoreduced. Although the existing literature is limited, it does show a consistent survival benefit, specifically in patients undergoing maximal cytoreduction to no gross evidence of disease. This article discusses various selection criteria that have been demonstrated to be predictive of successful surgery, as well as various prognostic factors that influence survival following secondary cytoreductive surgery.