Impact of Types of Cytoreductive Surgery on Survival and Morbidity in Recurrent Epithelial Ovarian Cancer
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To evaluate the survival benefits and procedural morbidity associated with iterative cytoreductive interventions in recurrent epithelial ovarian cancer (EOC), comparing outcomes across secondary, tertiary, and quaternary surgical procedures. STUDY DESIGN: A descriptive analytical study. Place and Duration of the Study: Department of Oncology, Azerbaijan Medical University, Narimanov, Azerbaijan, from 2014 to 2024. METHODOLOGY: A total of 349 patients undergoing secondary cytoreduction, including subsequent tertiary (n = 155) and quaternary (n = 55) interventions, were analysed. Multivariate analysis assessed prognostic variables, such as residual disease burden, platinum sensitivity, disease-free interval (DFI), recurrence patterns, and histopathological characteristics. Survival analysis employed Kaplan-Meier estimates with Cox proportional hazards modelling. RESULTS: Complete macroscopic resection (R0) significantly improved survival across all surgeries, including secondary (36.6 vs. 15.3 months, HR 0.42, 95% CI 0.31-0.58; p <0.001), tertiary (22.2 vs. 6.4 months, HR 0.38, 95% CI 0.24-0.61; p <0.001), and quaternary (29.1 vs. 10.5 months, HR 0.29, 95% CI 0.17-0.51; p <0.001). A DFI of more than 12 months, platinum sensitivity, and isolated recurrence were identified as favourable prognostic factors. Platinum-sensitive patients with a DFI greater than 12 months demonstrated superior median overall survival (OS) in the following categories: secondary: 50.2 vs. 15.5 months (p <0.001), tertiary: 47.1 vs. 8.5 months (p <0.001), and quaternary: 50.6 vs. 9.2 months (p <0.001). Morbidity increased with successive interventions but remained clinically manageable. Intraoperative complication rates were as follows: secondary 9.1%, tertiary 15.5%, and quaternary 9%; postoperative complication rates were as follows: secondary 4.9%, tertiary 15.5%, and quaternary 9%. CONCLUSION: Maximal-effort cytoreduction achieving R0 status significantly improves survival across multiple EOC recurrences when combined with platinum-based chemotherapy. DFI >12 months, isolated recurrence patterns, and platinum sensitivity emerge as critical selection criteria. KEY WORDS: Tertiary cytoreduction, Ovarian cancer recurrence, Surgical oncology, Survival outcomes, Peritoneal carcinomatosis.
Author: Akbar Ibrahimov
Institution: Azerbaijan Medical University
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7128919691
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