Article Text

other Versions

Download PDFPDF
Low-grade versus high-grade serous ovarian cancer: comparison of surgical outcomes after secondary cytoreductive surgery
  1. Serena Cappuccio1,
  2. Claudia Marchetti1,2,
  3. Defne Alara Altıntaş2,
  4. Riccardo Oliva2,
  5. Silvio Andrea Russo2,
  6. Barbara Costantini1,3,
  7. Diana Giannarelli4,
  8. Lorena Quagliozzi1,
  9. Giovanni Scambia1,2 and
  10. Anna Fagotti1,2
  1. 1Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  2. 2Università Cattolica del Sacro Cuore, Rome, Italy
  3. 3UniCamillus, Rome, Italy
  4. 4Epidemiology and Biostatistics Facility, G-STeP Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  1. Correspondence to Dr Anna Fagotti, Department of Woman’s and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; anna.fagotti{at}


Objective Retrospective series have shown secondary cytoreductive surgery improves oncological outcomes in recurrent low-grade serous ovarian cancer. We aim to compare surgical procedures and complications between patients with low-grade and high-grade recurrent serous ovarian cancer.

Methods This retrospective single-institution study includes patients with recurrent low-grade and high-grade serous ovarian cancer undergoing surgery between January 2012 to December 2021. Patients were propensity matched 1:3 for residual tumor at first surgery, presence of ascites and performance status. Complexity of surgery and postoperative complications were analyzed.

Results A total of 116 patients undergoing secondary cytoreductive surgery were included with 29 patients (25%) having low-grade ovarian cancer. The median age of the patients was 54 years (range: 19–85) and 57 years (range: 29–78) in low-grade and high-grade ovarian cancer, respectively (p=0.13). Stages III/IV at diagnosis were more frequent in patients with high-grade ovarian cancers (p<0.001). Peritoneal involvement was higher in low-grade compared with high-grade ovarian cancer as shown by the higher rate of diaphragmatic (41.4% vs 21.8%, p=0.05), abdominal wall (41.4% vs 18.4%, p=0.02) and pelvic (51.7% vs 21.8%, p=0.01) peritonectomy. Multiple bowel resections were higher in low-grade ovarian cancer (24.1% vs 8.0%, p=0.04), while high-grade ovarian cancer had a higher rate of nodal recurrences (73.2%% vs 37.9%, p=0.03). Overall, surgical complexity was higher in low-grade ovarian cancer (58.6% vs 36.8%; p=0.05), with higher median estimated blood loss (400 vs 200 mL; p=0.01) compared with high-grade. Complete cytoreduction was achieved in 26 patients (89.7%) with low-grade and 84 (96.6%) with high-grade (p=0.16) ovarian cancer, with no significant differences in postoperative complications.

Conclusions Secondary cytoreductive surgery in low-grade serous ovarian cancer patients was associated with higher complexity, multiple bowel resections, and higher median estimated blood loss than in high-grade serous ovarian cancer. The comparable rate of postoperative complications suggests that secondary cytoreductive surgery in this group of patients is feasible in expert centers.

  • ovarian cancer
  • cytoreduction surgical procedures
  • gynecologic surgical procedures
  • neoplasm recurrence, local
  • postoperative period

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @annafagottimd

  • Contributors Conception of study: AF and GS. Guarantor: AF and GS. Design and development: SC, CM and AF. Data collection: SC, RO, SAR, DAA, BC, LQ, CM Data analysis: SC, CM, DG. Preparation of tables: SC and CM. Initial draft of manuscript: SC, CM, DAA, RO. Manuscript writing, review, and approval: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.