Introduction There is insufficient evidence regarding appropriate follow-up investigations to detect secondary cytoreductive surgery (SCS) eligible recurrences in epithelial ovarian carcinoma (EOC). We aimed to evaluate the role of CA 125, physical examination, and radiological findings in a cohort of recurrent EOC treated with SCS.

Methods In this retrospective study clinical information of all women who had undergone SCS for the first recurrence of EOC at Tata Medical Center between January 2013 and December 2022 was extracted from electronic medical records. Relevant descriptive statistics were used in the analysis.

Results A total of 53 women underwent SCS and all had histopathology-proven relapse on surgical specimens. The median age was 54 years (IQR 46–61). The mean CA 125 value at recurrence was 172 U/mL (IQR 16.5–88.5). The sensitivity of CA 125 value to detect recurrences with a cut-off of 35 U/mL (upper level of normal) and 70 U/mL were 58.4% and 28.3% respectively. Physical examination alone had a sensitivity of 24.5% in detecting recurrence. Computed tomography (CT) detected recurrence with 94.3% sensitivity. Pelvis (24.5%) was the most common location of recurrence on imaging, followed by spleen (20.8%). There was moderate agreement between the CT scan detected location of recurrence and histopathologic findings (kappa 0.505, p<.001). CT scan could predict complete resection (CC0) in 84.9% of cases.

Conclusion/Implications Physical examination and CA 125 have low sensitivity in detecting SCS-eligible recurrences. Prospective studies of periodic cross-sectional imaging are warranted in the follow-up of EOC in the era of SCS.