Cytoreductive surgery for recurrent platinum-sensitive low-grade ovarian carcinoma: a retrospective single institution experience
Cytoreductive surgery with complete gross resection improves survival in selected patients with recurrent platinum-sensitive epithelial ovarian cancer. Limited data are available on sub-groups with rare histological sub-types undergoing cytoreductive surgery for recurrent disease. We analyzed the outcomes of patients with low-grade histologies undergoing surgery for recurrent disease. We performed a retrospective exploratory database analysis of patients undergoing cytoreductive surgery for recurrent platinum-sensitive low-grade epithelial ovarian cancer at a tertiary cancer center in Germany between 1999 and 2024. In total, 74 patients were included. The majority had low-grade serous histology (53 of 74 [72%]). Median progression-free survival to first recurrence was 34.1 months. The most common surgical procedures were peritonectomy (72%), lymphadenectomy (34%), and large-bowel resection (30%). The stoma rate was 11%. Complete gross resection was achieved in 51 of 74 patients (69%), and 7 patients (9.5%) had residual disease of 1 to 10 mm. The rate of severe complications (Clavien-Dindo grade ≥3) was 12%. In total, 84% of patients received chemotherapy and 11% received endocrine therapy after surgery. Median progression-free survival and overall survival after cytoreductive surgery for recurrence were 26.5 months and 93 months, respectively. On multi-variate analysis, complete gross resection versus residual disease > 10 mm (p = .002) was the only significant factor for overall survival. Cytoreductive surgery for patients with recurrent platinum-sensitive low-grade ovarian cancer appears feasible and may be associated with clinical benefit. Given the surgical risks and an 11% stoma rate, careful patient selection is essential. Complete gross resection was associated with improved progression-free and overall survival. Additional research is needed to clarify whether a survival benefit exists in cases with residual disease of 1 to 10 mm.
