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Surgery for Recurrent Epithelial Ovarian Cancer in the Netherlands: A Population-Based Cohort Study
  1. Rafli van de Laar, MD*,,,
  2. Roy F.P.M. Kruitwagen, MD, PhD,,
  3. Joanna IntHout§,
  4. Petra L.M. Zusterzeel, MD, PhD*,
  5. Toon Van Gorp, MD, PhD, and
  6. Leon F.A.G. Massuger, MD, PhD*
  1. *Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen;
  2. Department of Obstetrics and Gynecology, Maastricht University Medical Centre; and
  3. GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht; and
  4. §Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
  1. Address correspondence and reprint requests to Rafli van de Laar, MD, Department of Obstetrics and Gynecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail:


Objective The value of secondary cytoreductive surgery (SCS) in patients with recurrent epithelial ovarian cancer is controversial. The aim of this population-based study was to investigate the role of SCS in the Netherlands.

Methods Data of 408 patients who underwent SCS between 2000 and 2013 were retrospectively collected from 38 Dutch hospitals. Survival after complete and incomplete SCS was estimated by Kaplan-Meier curves. Factors associated with overall survival (OS) were explored with Cox regression.

Results Median OS after SCS was 51 months (95% confidence interval [95% CI], 44.8–57.2). Complete SCS was achieved in 295 (72.3%) patients, with an OS of 57 months (95% CI, 49.0–65.0) compared with 28 months (95% CI, 20.8–35.2) in patients with incomplete SCS (log-rank test; P < 0.001). Nonserous histology (HR 0.65; 95% CI 0.45–0.95), a long progression free interval (hazard ratio [HR], 0.29; 95% CI, 0.07–1.18), a good performance status (HR, 0.68; 95% CI, 0.49–0.94), SCS without preoperative chemotherapy (HR, 0.72; 95% CI, 0.51–1.01), and complete SCS (HR, 0.46; 95% CI, 0.33–0.64) were prognostic factors for survival.

Conclusions This population-based retrospective study showed that there might be a role for SCS in recurrent epithelial ovarian cancer especially when complete SCS can be accomplished. However, before adopting SCS as a standard treatment modality for recurrent epithelial ovarian cancer, results of 3 ongoing prospectively randomized trials are needed.

  • Recurrent
  • Ovarian cancer
  • Secondary cytoreductive surgery

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  • The authors declare no conflicts of interest.

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