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Review
. 2023 Jul 2;15(13):3470.
doi: 10.3390/cancers15133470.

Surgery in Recurrent Ovarian Cancer: A Meta-Analysis

Maria Teresa Climent  1   2 , Anna Serra  1   2 , Maria Llueca  3 , Antoni Llueca  1   2
Affiliations
Review

Surgery in Recurrent Ovarian Cancer: A Meta-Analysis

Maria Teresa Climent et al. Cancers (Basel). .

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.

Keywords: disease-free survival; meta-analysis; overall survival; recurrent epithelial ovarian cancer; secondary cytoreductive surgery; systematic revision.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
PRISMA diagram showing the selection process of the articles included in the study.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Risk of bias graph.
Figure 4
Figure 4
(a): Statistical study OS: Results obtained from all studies included in the review. (b): Statistical study DFS: Results obtained from all studies included in the review. (c): Subgroup analysis of overall survival with complete cytoreductive surgery vs. residual tumor. (d): Subgroup analysis of disease-free survival with complete cytoreductive surgery vs. residual tumor.
Figure 4
Figure 4
(a): Statistical study OS: Results obtained from all studies included in the review. (b): Statistical study DFS: Results obtained from all studies included in the review. (c): Subgroup analysis of overall survival with complete cytoreductive surgery vs. residual tumor. (d): Subgroup analysis of disease-free survival with complete cytoreductive surgery vs. residual tumor.
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