Relapse: Surgical considerations and secondary cytoreduction

This chapter focuses on the survival bene fi t, selection criteria, and morbidity and mortality associated with secondary cytoreduction for recurrent ovarian cancer in the general population and the elderly. The goal of secondary cytoreduction is to improve overall survival by maximizing surgical tumor eradication in patients who demonstrate a complete clinical response to initial platinum-based chemotherapy. Retrospective studies consistently demonstrate a survival bene fi t associated with maximal secondary cytoreduction. Patient selection criteria should be individualized based on the patient's life goals, comorbidities and performance status, and availability of adjuvant therapy. Morbidity and mortality rates are comparable to those associated with primary cytoreduction. The role of secondary cytoreduction in the geriatric population is still evolving. In general, elderly are less likely to receive standard treatment for ovarian cancer, but research suggests that secondary cytoreduction can be both safe and feasible and advanced age alone should not be a contraindication to surgery.