The Role of Surgical Reexploration Following Chemotherapy in Ovarian Cancer


Abstract

Summary: Two hundred and eighty three patients with FIGO Stages III-IV ovarian epithelial cancer were entered on a randomized trial of chlorambucil with or without cisplatin. Eighty two of these patients have subsequently undergone surgical reexploration. Ten of these were for surgical indications (intestinal obstruction, etc.), and 7 were interval reexplorations at about 6 months on patients who had not been adequately debulked at primary surgery. The remaining 65 patients had elective operations after 12 months chemotherapy, and in 52 of these there was no pre-operative clinical evidence of residual disease. Complete Surgical Response rate (CRS) was similar in the 2 treatment arms (8% v 9.7%); 42.3% of patients in apparent remission at 12 months had negative reexploration and 57.5% of these were alive after 4 years (post-reexploration median survival > 4!/2 years). The remaining 57.7% of patients had residual disease at reexploration and their 4-year survival was 15% (median survival 73 weeks).

A further group of 13 patients had ‘responding’ and probably resectable residual disease at 12 months. These patients were reexplored with a view to secondary debulking. Their 4-year postoperation survival was 15% (median survival, 70 weeks). There were 9 patients who, though in apparent remission at 12 months, were not subjected to surgical reexploration. The median survival for this group was 33 weeks, calculated from the mean theoretical time when they should have had reexploration. This was significantly inferior to the results for the 52 patients, also in apparent remission, who underwent reexploration (4-year survival 32.5%, median survival 123 weeks, p = 0.002).

Ancillary