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Abstract
Introduction/Background Survival benefit of secondary cytoreductive surgery (SCS) in platinum-sensitive relapsed ovarian cancer (PSROC) has been demonstrated in recent randomised controlled trials. Data on SCS for PSROC from resource-limited settings are scarce. This study aimed to evaluate the perioperative and oncologic outcomes of SCS in Indian women with PSROC.
Methodology A review was conducted for all patients who underwent SCS for PSROC between 2012 and 2021 at Tata Medical Center. Clinical information including patient and disease characteristics, surgical details, and survival data was extracted from electronic medical records. Survival analysis was done using Kaplan-Meier method and Cox Proportional Hazards model.
Results Fifty patients (age 30–71) underwent SCS for PSROC with complete cytoreduction (CC0) achieved in 35 (70%) patients. The majority had high-grade serous carcinoma (78%), and most patients (88%) relapsed more than 12 months after platinum-based chemotherapy. SCS involved bowel resection in 24% of patients with stoma in 10%. Clavien-Dindo grade 3 or higher complications occurred in 4 (8%) patients. Postoperative 30-day mortality rate was 2%. Maintenance therapy with bevacizumab, and poly ADP ribose polymerase (PARP) inhibitor was used in 28% and 8% of patients respectively. The median progression-free survival (PFS) was 16 months (95% confidence interval [CI], 13.9 to 18.1), and the median overall survival (OS) was 38 months (95% CI, 32.3 to 43.7). Patients with CC0 had a better PFS than those without CC0 (18 months vs. 14 months; hazard ratio, 0.38; 95% CI, 0.18 to 0.8; P=0.01) but not OS. There was no significant difference in PFS and OS among other potential prognostic subgroups.
Conclusion Secondary cytoreductive surgery in PSROC had minimal complications. Progression-free survival was comparable to randomised studies while overall survival was lower. Patients with complete cytoreduction had better progression-free survival.