The Role of Secondary Cytoreductive Surgery in Relapsed Ovarian Cancer: A Comprehensive Review

Pages 01–09

Karaiskos I¹, Apostolopoulos A², Peppas G¹, Spiliotis J³

¹Psychikon Medical Center, Athens, Greece; ²YGIA Polyclinic, Limessol, Cyprus; ³Interbalkan Medical Center, Thessaloniki, Greece

Abstract: Ovarian cancer is the second most common and the most lethal gynecological malignancy worldwide, with approximately two-thirds of patients presenting with advanced-stage disease. The standard of care consists of cytoreductive surgery, either primary or following neoadjuvant chemotherapy, combined with platinum-based chemotherapy. Despite advances in surgical techniques and the development of novel chemotherapeutic agents, most women with ovarian cancer ultimately experience recurrence and succumb to the disease. In contrast to primary disease management, the optimal treatment strategy for recurrent ovarian cancer remains a subject of ongoing debate. While platinum-based or second-line systemic chemotherapy, depending on the platinum free interval, is the current standard, the role of secondary cytoreductive surgery has long been controversial. Any potential survival benefit must be carefully balanced against the risks of significant surgical morbidity, potential deterioration in quality of life, and economic cost. In cases of platinum-resistant recurrence, defined as relapse occurring within six months of completing platinum based chemotherapy, secondary cytoreduction is generally not recommended due to the aggressive tumor biology and limited efficacy of systemic treatments. This comprehensive review focuses on the current role of cytoreductive surgery in platinum-sensitive recurrent ovarian cancer, with a detailed discussion of recent randomized trials and meta-analyses. Emerging evidence supports a role for secondary cytoreductive surgery in carefully selected patients where complete resection of macroscopic disease is achievable. However, its indication must be continually reassessed in light of the evolving landscape of systemic therapies for recurrent ovarian cancer.

Keywords: Recurrent ovarian cancer, secondary cytoreductive surgery, platinum-sensitive chemotherapy, hyperthermic intraperitoneal chemotherapy.