Has the “paradigm shift” in the management of advanced ovarian, tubal and primary peritoneal cancer altered the locations of recurrence?

Purpose of investigation: To determine the pattern of disease recurrence in patients treated for advanced ovarian cancer (AOC). Materials and Methods:A retrospective review of the locations of recurrence in all patients treated for AOC between August 16, 2007 and February 3, 2014 who underwent cytoreductive surgery and platinum based chemotherapy achieving complete (R0) or optimal (< 1cm) (R1) cytoreduction. Results: The study identified 254 patients. Peritoneal site relapses affected 65.4–91.1% of patients and were more common in R1 compared to R0 patients (p = 0.01891). Ascites at relapse was less prevalent in R0 compared to R1 patients (p = 0.00185) and occurred less with more complex surgery (p = 0.00497) and 19.2% of patients who required high complexity surgery to achieve R0 only experienced retroperitoneal recurrences. Conclusion: Irrespective of the surgery undertaken, the peritoneum is the commonest site of recurrence. The surgical complexity required to achieve R0 seemingly alters the relapse pattern by reducing ascites and peritoneal relapse compared to those with R1 disease, and increasing retroperitoneal relapse.

Ovarian cancer; Fallopian tube cancer; Peritoneal neoplasms; Recurrence; Surgery.

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