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

F Falcone, G Scambia, P Benedetti Panici, M Signorelli, G Cormio, G Giorda, S Bogliolo, M Marinaccio, F Ghezzi, E Rabaiotti, E Breda, G Casella, F Fanfani, V Di Donato, U Leone Roberti Maggiore, S Greggi

Research output: Contribution to journalArticlepeer-review


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 ≥6month 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 60days 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 ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 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 ≥6month 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.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalGynecologic Oncology
Issue number1
Publication statusPublished - Oct 2017


  • Adult
  • Aged
  • Cytoreduction Surgical Procedures
  • Female
  • Humans
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Neoplasms, Glandular and Epithelial
  • Ovarian Neoplasms
  • Retrospective Studies
  • Risk Factors
  • Young Adult
  • Journal Article
  • Multicenter Study


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