Introduction/Background Two randomized controlled trials on the role of secondary cytoreductive surgery in platinum-sensitive Recurrent Ovarian Cancer (ROC) patients have shown contrasting results in terms of PFS and OS. Even more debated is the role of surgery in the tertiary setting. This study aims to investigate the current literature on tertiary cytoreductive surgery (TCS) in ROC and to perform a meta-analysis to examine the impact of optimal and sub-optimal TCS on survival.
Methodology A systematic literature review was performed. PubMed, Scopus and Web of Science were searched to retrieve studies published in English and Italian up to 31st March 2019. Quantitative data were pooled out to compare interventions through a meta-analysis. PRISMA statement was used for reporting.
Results Literature search led to 706 records. Of 29 full-text articles obtained after deduplication and screening, 17 were excluded as they didn’t meet eligibility criteria. The remaining 12 studies were all retrospective. The majority had small size cohorts, and a wide heterogeneity in outcome measures and number and type of covariates was observed. Five studies were eligible for meta-analysis, including a total of 694 patients. Overall pooled HR comparing optimal/complete versus suboptimal/partial cytoreduction was 3.17 (CI95: 1.90–5.29; p<0.001) with moderate heterogeneity (I 2: 56.2%; p=0.058), suggesting a protective effect of optimal TCS. Pooled HR for studies considering Disease Specific Survival, comparing residual tumor (RT) <0.5 cm versus >0.5 cm after TCS, was 3.29 (CI95: 1.88–5.73; p<0.001) with low heterogeneity (I 2: 17.4%; p=0.271). Pooled HR for studies considering Overall Survival, comparing RT <0. versus >0 after TCS, was 3.29 (CI95: 1.88–5.73; p <0.001) with very high heterogeneity (I 2: 80.1%; p=0.025).
Conclusion Our data suggests surgery might play a major role in improving survival of patients with ROC in tertiary setting. Nevertheless, the topic remains under-investigated and further studies are needed.
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