Role of tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: Systematic review and meta-analysis

• Published in: Gynecologic oncology 2022-07, Vol.166 (1), p.181-187
• Main Authors: Guida, Francesco, Dioun, Shayan, Fagotti, Anna, Melamed, Alexander, Grossi, Adriano, Scambia, Giovanni, Wright, Jason D., Tergas, Ana I.
• Format: Article
• Language: English
• Subjects: Epitelial ovarian cancer; Optimal cytoreduction; Second relapse; Survival; Tertiary cytoreductive surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2022.04.005

To evaluate the clinical utility of tertiary cytoreductive surgery (TCS) in recurrent ovarian cancer. MEDLINE via PubMed, Embase (Elsevier), ClinicalTrials.gov, Scopus (Elsevier) and Web of Science for studies from inception to 4/09/2021. Studies reporting disease specific survival (DSS) and overall survival (OS) among women who underwent optimal cytoreductive surgery as compared to those who had a suboptimal cytoreductive surgery at time of TCS were abstracted. Study quality was assessed with the Quality In Prognosis Studies (QUIPS) tool. The data were extracted independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between survival and surgical outcomes. 10 studies met all the criteria for inclusion in the systematic review. Patients with optimal tertiary cytoreductive surgery had better DSS (HR = 0.35; 95% CI, 0.19–0.64, P < 0.001), with low heterogeneity (I2 = 0%, P = 0.41) when compared to those with suboptimal tertiary cytoreductive surgery. Pooled results from these studies also demonstrated a better OS (HR = 0.34; 95% CI, 0.15–0.74, P < 0.007) with moderate heterogeneity (I2 = 59%, P = 0.09) when compared to patients with a suboptimal tertiary cytoreductive surgery. This remained significant in a series of sensitivity analyses. Due to the limited number of studies, we were unable to do further subgroup analyses looking at outcomes comparing tertiary cytoreductive surgery to chemotherapy. In this systematic review and meta-analysis of observational studies examining tertiary cytoreductive surgery for recurrent ovarian cancer, optimal tertiary cytoreductive surgery was associated with improved OS and DSS survival compared to suboptimal tertiary cytoreductive surgery. •There is limited data on tertiary cytoreductive surgery for recurrent ovarian cancer.•A systematic review of the literature identified ten studies evaluating the role of tertiary cytoreductive surgery.•Optimal cytoreductive surgery was associated with improved OS and DSS compared to suboptimal tertiary cytoreductive surgery