Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study

Objectives: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. Methods: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. Results: A total of 103 EOC patients with a â ¥. 6. month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60. days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed â ¥. 3. years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43. months, 95% CI 31-58) compared to those with residual tumor (median OS: 33. months, 95% CI 28-46; p <. 0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. Conclusions: This is the only large multicentre study published so far on TCS in EOC with â ¥. 6. month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.