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 ≥ 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 ≥ 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 ≥ 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. © 2017 Elsevier Inc.
Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalGynecologic Oncology
Issue number1
Publication statusPublished - 2017


  • Cytoreductive surgery
  • Quality of surgery
  • Recurrent ovarian cancer
  • adult
  • aged
  • Article
  • cancer mortality
  • cancer recurrence
  • cancer survival
  • cytoreductive surgery
  • female
  • human
  • major clinical study
  • minimal residual disease
  • multicenter study (topic)
  • ovary carcinoma
  • overall survival
  • postoperative complication
  • priority journal
  • retroperitoneal cancer
  • retrospective study
  • clinical trial
  • middle aged
  • mortality
  • multicenter study
  • multivariate analysis
  • Neoplasms, Glandular and Epithelial
  • Ovarian Neoplasms
  • pathology
  • procedures
  • risk factor
  • tumor recurrence
  • young adult
  • Adult
  • Aged
  • Cytoreduction Surgical Procedures
  • Female
  • Humans
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Retrospective Studies
  • Risk Factors
  • Young Adult


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