Objectives Low-grade serous ovarian cancer (LGSC) is a relatively chemo-resistant disease with limited effective treatment options for patients with recurrence. Secondary cytoreductive surgery (SCS) is commonly offered to women with recurrent LGSC, although the effect of cytoreductive outcomes following SCS on survival is yet to be determined. This systematic review/meta-analysis aims to evaluate the impact of SCS with gross residual disease (GRD) versus SCS with no GRD on overall survival (OS) and progression-free survival (PFS) in recurrent LGSC.

Methods A comprehensive search of MEDLINE, EMBASE, Cochrane Central, Cochrane Database of Systematic Reviews, and Web of Science was conducted to obtain all studies evaluating SCS with GRD versus no GRD in recurrent LGSC. Meta-analysis was performed on OS and PFS, and assessed using the Cochrane Risk of Bias in Non-Randomized Studies (ROBINS)-1 tool. Forest plots with pooled Hazard Ratios (HR) were generated.

Results Three retrospective cohort studies evaluating 112 LGSC patients who underwent SCS were included in the meta-analysis. Two studies were meta-analyzed for OS (n=71) and PFS (n=91), respectively. There were 35 (31.2%) participants with no GRD at SCS, and 77 (68.8%) participants left with GRD at SCS. GRD at SCS negatively impacted PFS (HR=3.51, 95% CI= 1.72, 7.14), and SCS with no GRD significantly improved OS (HR=0.4, 95% CI=0.23, 0.7).

Conclusions Optimal SCS with no GRD may prolong OS and PFS in women with recurrent LGSC. The quality of evidence of the included studies is low and demonstrates the need for prospective studies investigating the role of SCS in women with LGSC.