Surgery in Recurrent Ovarian Cancer: A Meta-Analysis

SIMPLE SUMMARY: Ovarian cancer has the highest mortality rate of any type of gynecological cancer because it is diagnosed in advanced stages and its recurrence rate is about 80%. The standard treatment for recurrences of ovarian cancer is systemic chemotherapy. Secondary cytoreductive surgery may be a treatment option for selected patients. We evaluated three randomized studies to determine the effect on overall survival and disease-free survival. This analysis shows better results in this group than in the patients who were treated with chemotherapy alone, with statistically significant differences. This benefit is maintained when analyzing patients in whom complete cytoreduction is achieved. The main limitation of the selected studies is the different criteria for selecting patients for secondary cytoreduction, which is why prospective studies are needed to determine which patients will benefit from this treatment. ABSTRACT: Background: The second cytoreductive surgery performed for a patient who has recurrent ovarian cancer remains controversial. Our study analyzes overall survival (OS) and disease-free survival (DFS) for cytoreductive surgery in addition to chemotherapy in recurrent ovarian cancer instead of chemotherapy alone. Methods: A meta-analysis was conducted using PubMed and the Cochrane database of systematic reviews to select randomized controlled studies. In total, three randomized studies were used, employing a total of 1249 patients. Results: The results of our meta-analysis of these randomized controlled trials identified significant differences in OS (HR = 0.83, IC 95% 0.70–0.99, p < 0.04) and DFS (HR = 0.63, IC 95% 0.55–0.72, p < 0.000001). A subgroup analysis comparing complete cytoreductive surgery and surgery with residual tumor achieved better results for both OS (HR = 0.65, IC 95% 0.49–0.86, p = 0.002) and DFS (HR = 0.67, IC 95% 0.53–0.82, p = 0.0008), with statistical significance. Conclusions: A complete secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) demonstrates an improvement in the OS and DFS, and this benefit is most evident in cases where complete cytoreductive surgery is achieved. The challenge is the correct patient selection for secondary cytoreductive surgery to improve the results of this approach.