Primary versus secondary cytoreduction for epithelial ovarian cancer: a paired analysis of tumour pattern and surgical outcome

Abstract

Objective: Recurrence rates of Epithelial Ovarian Cancer (EOC) remain high. Aim of the present study was to compare tumour pattern and surgical outcome at primary and secondary tumourdebulking in a paired patients' collective.

Methods: Seventy-nine consecutive EOC-patients who underwent both primary and secondary cytoreduction in our institution between 09/2000 and 12/2010 were evaluated according to a validated documentation-tool ('IMO', Intraoperative Mapping Ovarian Cancer). Differences in tumour-pattern between paired samples were examined using McNemar-test or sign-test.

Results: A complete macroscopic tumour resection could be achieved significantly more often during primary versus secondary surgery (77% versus 50%; p<0.001) in comparable operative times (242 min versus 199 min; p=0.15) and by equivalent operative morbidity (25% versus 29%; p=0.424). Tumour-residuals at primary correlated significantly with tumour-residuals at secondary cytoreduction (p=0.003). Patients at relapse had significantly higher rates of tumour involvement of the gastric serosa (2.5% versus 16.9%; p=0.001), serosa of small intestine (20.3% versus 44.9%; p<0.001) and mesentery (30.4% versus 50%; p=0.012). The relative-risk for peritoneal carcinosis, intestinal tumour involvement or positive lymph nodes at secondary tumourdebulking in the case of presence of these features at primary surgery was 1.53 (95% CI: 0.89-2.63); 0.92 (95% CI: 0.65-1.31) and 1.49 (95% CI: 0.83-2.68), respectively, and thus not reaching a statistical significance.

Conclusions: Secondary cytoreduction due to EOC appears to be associated with significantly lower optimal tumourdebulking rates compared to primary setting, since the disease tends to recur in patterns less accessible to complete resection such as gastrointestinal serosa, mesentery and upper abdomen. By maximal surgical effort, tumour residuals significantly correlate between primary and secondary cytoreduction. No other predictors of surgical outcome or tumour-pattern could be identified.