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 theMITO Group on a 5-year observation period. Results. A total of 103 EOC patients with a ≥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 ofmortality within 60 days from surgery.Multivariate analysis identified the complete tertiary cytoreduction as themost potent predictor of survival followed by FIGO stage I–II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥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 b 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 ≥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.