Complete surgical resection of isolated recurrent high-grade epithelial ovarian cancer in highly selected patients without chemotherapy is associated with an excellent outcome.

ABSTRACT

The purpose of this study was to determine the outcome for patients with recurrent ovarian cancer treated with surgical resection alone. Consecutive patients were identified who had complete resection of a surgically isolated metastasis of recurrent high-grade ovarian cancer between 1/2006 and 1/2018 who did not receive adjuvant chemotherapy. Eight such patients were identified. The mean age was 54.4 yrs. (range, 46.1-62.9 yrs). Six of the 8 patients (75%) had a complete resection at initial surgery and all but one (88%) were initially treated with intraperitoneal chemotherapy. The median time from completion of primary chemotherapy to recurrence was 38.7 mo (14.4-96.4 mo). Sites of recurrence included lymph nodes (n = 2), spleen (n = 1), and peritoneal cavity (n = 5). Minimally invasive surgical techniques were used in 7 of the 8 patients. Mean progression-free survival after secondary surgery was 19.8 mo (95% CI, 15.8-N.R.) and mean overall survival was 64.8 mo (95% CI, 54.6-N.R.). With a median follow-up of 65.2 months (23.3-84.6 mo) from the secondary resection, 4 of 8 patients remain without evidence of recurrence. Only 1 of the 5 patients with peritoneal recurrence remains disease-free. All 4 patients in remission have a post-resection time longer than the time from initial treatment to the surgery for recurrence. This study finds that it may be reasonable to omit chemotherapy in highly selected patients after complete secondary surgical resection. Resection of isolated recurrences can be accomplished with minimally invasive surgery, and these patients have an excellent prognosis. Non-peritoneal recurrences may have a better prognosis after secondary surgery.