Secondary cytoreductive surgery for ovarian cancer.

Secondary cytoreduction to optimal levels can be successfully accomplished in a substantial number of ovarian cancer patients and in a variety of clinical settings. Although frequently complex, secondary operations can be performed with acceptable morbidity. All operations should be undertaken by experienced oncologic surgeons. Prospective randomized clinical trials to evaluate the survival benefits of secondary cytoreduction will probably never be conducted. Consequently, estimates of survival benefit must be derived from the evaluation of outcome in clinically homogeneous subsets. There is good evidence that a survival advantage can be obtained in patients whose gross disease is completely resected at second-look laparotomy and in patients whose disease recurs after a complete response to primary cytoreduction and cisplatin-based chemotherapy. Patients who fail to respond to primary treatment are probably not appropriate candidates for a secondary resection. Because most patients are left with at least microscopic residual disease, the lack of effective second-line chemotherapy limits the survival impact of secondary cytoreduction.