Introduction/Background Retrospective series have shown secondary cytoreductive surgery (SCS) improves oncological outcomes in recurrent low-grade serous ovarian cancer (LGSOC), a relatively chemoresistant subtype. We aim to describe surgical procedures and complications, for this subset of patients compared to the high-grade serous ovarian cancer (HGSOC) counterpart.

Methodology This is a retrospective single-institution study on patients affected by platinum sensitive recurrent LGSOC and HGSOC undergoing SCS between 2009–2021. Patients were matched for clinical characteristics such as age, stage, residual tumor at first surgery, and platinum-sensitivity. Complexity of surgery was assessed by Aletti’s score and post-operative complications by Clavien Dindo classification.

Results Fifty-two patients undergoing SCS were included in our analysis. Patients’ characteristics are described in table 1. Recurrence was mainly localized in the peritoneum in both groups but reached a statistically significant higher rate for the diaphragm (38.5% vs 11.5%, p=0.026) and the small bowel (53.8% vs 7.7%, p<0.001) in LGSOC compared to HGSOC counterpart. On the contrary, HGSOC showed a higher rate of nodal recurrences than LGSOC (38.5% vs 23.1%, p= 0.18). Overall, surgical complexity (Aletti’s score group >1) was higher in LGSOC than in HGSOC patients (65.4% vs 37.5%; p=0.045), with LGSOC cases undergoing multiple bowel resections more frequently than HGSOC (26.9% vs 3.8%; p=0.025). Median EBL was also higher in LGSOC than in HGSOC patients (400 vs 100 ml; p=0.036). Twenty-five patients achieved optimal residual disease after SCS in both groups (p=0.75) with no statistically significant differences in term of post-operative complications.

Conclusion SCS in LGSOC patients is associated with higher complexity, multiple bowel resections, and higher median estimated blood loss than in HGSOC. However, the comparable rate of post-operative complications confirms the role of SCS in this group of patients.