The surgical management of recurrent ovarian cancer is a challenging but integral part of treatment in selected patients. The available data have demonstrated superior survival in the subset of patients who can achieve optimal cytoreduction compared with the subset in whom optimal cytoreduction cannot be achieved. Additional attempts at tumor cytoreduction should be considered and offered in the management of patients with recurrent epithelial ovarian carcinoma who are medically able to undergo surgery and willing to accept additional postoperative chemotherapy. Several factors predict successful cytoreduction and should be evaluated before surgery (Box 10-4).
There is no published randomized trial in the setting of recurrent ovarian cancer addressing the role of surgery. However, this issue is being evaluated in a recently activated GOG trial. While awaiting the results of this trial, the clinician managing patients needs to make critical decisions regarding the potential benefits and risks of further surgical intervention. Box 10-5 summarizes the factors that need to be taken into consideration and Table 10-2 offers suggested selection criteria for secondary cytoreduction for patients with recurrent ovarian cancer.
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