Introduction The optimal timing and number of cytoreductive surgery (CRS) procedures in patients with multiple recurrences are still under debate. The aim of study is to evaluate the outcomes and safety of tertiary cytoreductive surgery in secondary relapsed ovarian cancer patients.

Methods We retrospectively reviewed the medical records of secondary relapsed recurrent ovarian cancer patients between January 2000 and March 2023.

Results A total of 123 patients (26 patients who underwent tertiary cytoreductive surgery (TCS) followed by chemotherapy vs. 97 patients who received chemotherapy alone after secondary relapse) were included. The median age was 46.8 years, and the median follow-up time was 64.8 months. Among the patients with TCS, 5 (19.2%) and 1 (3.8%) patients received quaternary and quinary CRS, respectively. 24(92.3%) patients received complete resection in TCS, and post operative adjuvant chemotherapy was administered to 22(84.6%) patients. Out of 26 patients, 18(69.2%) experienced recurrence after TCS, with a median time to recurrence of 22.1 months. Patients with complete tertiary cytoreductive surgery had a significantly longer overall survival (median overall survival (OS): 93 months, p = 0.001) compared to those with chemotherapy alone group. (median OS: 47 months, 95% CI 39.0 – 54.9).

Conclusion/Implications Our study suggests that third or more CRS in recurrent ovarian cancer is associated with survival benefit. The outcomes of third or more CRS are influenced by the extent of CRS, with complete CRS associated with better outcomes. The decision to offer third or more CRS should be individualized based on patient factors, including overall health status and extent of disease.