Many published retrospective and some prospective nonrandomized series have reported an association between improved survival and optimal secondary surgical cytoreduction (see Table 10-1). Survival ranges from 7 to 27 months for patients without an optimal cytoreduction, 19 to 56 months for patients with optimal cytoreduction, and 24 to 50 months for patients with no residual disease after secondary cytoreduction. There is obviously a great overlap of reported survival rates among the various series. When taken separately, complete resection is clearly superior, but comparisons across publications demonstrate that the difference between optimal disease and no macroscopic residual is less clear.
Bristow and colleagues44 recently performed a meta-analysis of studies on cytore-ductive surgery for recurrent ovarian cancer. The purpose of the study was to determine the relative effect of multiple prognostic variables on overall postrecurrence survival time among cohorts of patients with recurrent ovarian cancer undergoing cytoreductive surgery. They analyzed 40 cohorts of patients including over 2000 cases. The only statistically significant clinical variable independently associated with postrecurrence survival time was the percentage of patients undergoing complete cytoreductive surgery. After controlling for all other variables, each 10% increase in the proportion of patients undergoing complete cytoreductive surgery was associated with a 3-month increase in median cohort survival time (Fig. 10-5).
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