Secondary Cytoreductive Surgery

First-line treatment for advanced ovarian cancer consists of cytoreductive surgery in combination with platinum-based chemotherapy. Patients with no macroscopic residual disease after surgery have a better progression-free (PFS) and overall survival (OS) in comparison to patients who underwent cytoreduction to minimal or large residual tumor. This chapter discusses cytoreductive surgery for relapsed diseases aiming at prolongation of PFS and OS. To define the role of secondary cytoreductive surgery (SCS) in relapsed ovarian cancer, one need to address three important topics: Patient selection for SCS, Feasibility and morbidity associated with SCS, and Potential benefit of successful SCS. SCS-associated mortality and morbidity appear to be moderate compared to the mortality and morbidity of primary debulking surgery. Granulosa cell tumors have an indolent nature and are best managed surgically. Relapse of granulosa cell tumors occurs most frequently in the abdominal or retroperitoneal space. SCS appears to be feasible in relapsed granulosa cell tumors.