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The role of surgery in recurrent ovarian cancer
  2. P. HARTER,
  3. U. CANZLER,
  4. B. RICHTER§,
  6. M. HAHMANN,
  8. A. BURGES#,
  9. S. LOIBL**,
  10. M. GROPP††,
  11. J. HUOBER‡‡,
  12. D. FINK§§,
  13. A. DU BOIS,
  14. for the AGO Ovarian Committee¶¶,
  15. the AGO Ovarian Cancer Study Group (AGO-OVAR)¶¶
  1. *Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
  2. Gynäkologie und Gyn. Onkologie, HSK, Dr Horst Schmidt Klinik, Wiesbaden, Germany
  3. Klinik für Frauenheilkunde Universitätsklinikum Dresden, Dresden, Germany
  4. §Elblandkliniken Radebeul, Radebeul, Germany
  5. Klinik für Gynäkologie Universitätsklinikum Marburg, Marburg, Germany
  6. Koordinierungszentrum Klinische Studien, Universität Marburg, Marburg, Germany
  7. #Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Freiburg, Freiburg, Germany
  8. **Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum München Großhadern, Munich, Germany
  9. ††Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Frankfurt, Frankfurt, Germany
  10. ‡‡Klinik für Gynäkologie und Geburtshilfe EVK Düsseldorf, Düsseldorf, Germany
  11. §§Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Tübingen, Tübingen, Germany
  12. ∥∥Universitätsfrauenklinik Zürich, Zürich, Switzerland
  1. Address correspondence and reprint requests to: Prof. Dr. Jacobus Pfisterer, Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Michaelisstr. 16, 24105 Kiel, Germany. Email: jpfisterer{at}


The role of cytoreductive surgery (CS) in recurrent ovarian cancer (ROC) has not been clearly defined. We performed a retrospective study evaluating criteria for CS in ROC. Twenty-five institutions documented their patients with CS for invasive epithelial ROC performed 2000–2003. Two hundred sixty-seven patients were included. Complete tumor removal was achieved in 133 patients (50%). Complete resection was associated with prolonged survival compared to surgeries with residual tumor. Median survival of patients without residual tumor was 45.3 months and of patients with residual tumor, irrespective of its size, 19.0 months (HR 4.33; 95% CI 2.53–7.43; P < 0.0001). In a multivariate analysis, the following factors showed a significant influence on the probability to achieve a postoperative residual tumor of 0 mm: absence of ascites (<500 vs ≥500 mL: HR 4.63; 95% CI: 1.81–11.76; P = 0.0001), good performance status Eastern Cooperative Oncology Group (ECOG) 0 vs >0: HR: 2.41; 95% CI: 1.41–4.08; P = 0.001, and low FIGO stage at primary diagnosis (FIGO I/II vs III/IV: HR 1.87; 95% CI: 1.04–3.37; P = 0.036). Significant factors for survival after surgery for recurrence in a multivariate analysis were achievement of complete resection (residual tumor at surgery for recurrence 0 vs >0 mm: HR 2.86; 95% CI: 1.66–4.93; P < 0.001), absence of ascites (<500 vs ≥500 mL: HR 2.09; 95% CI: 1.18–3.71; P = 0.012), and application of a platinum-containing chemotherapy (platinum-containing chemotherapy vs others: HR 1.83; 95% CI: 1.16–2.88; P = 0.009). Only patients with complete resection seem to benefit from CS. This new panel of selection criteria will be evaluated in a prospective study.

  • ovarian cancer
  • recurrence
  • surgery

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  • ¶¶ Further members of the study-coordinating group of the AGO-OVAR and the AGO ovarian committee who contributed to this study are (in alphabetic order): G.P. Breitbach (Neunkirchen), G. Emons (Göttingen), V. Heilmann (Ulm), W. Kuhn (Bonn), H.J. Lück (Hannover), H.G. Meerpohl (Karlsruhe), K. Münstedt (Gießen), O. Ortmann (Regensburg), B. Schmalfeldt (München rdI), W. Schröder (Bremen), J. Sehouli (Berlin), B. Tanner (Mainz), P. Wimberger (Essen), K. Wollschlaeger (Magdeburg).