Abstract

Management of recurrent disease is extremely important in ovarian cancer treatment. Today, recurrent surgeries and various chemotherapy steps are used in the management of recurrences. Secondary, tertiary and quaternary surgeries are integral parts of recurrent epithelial ovarian cancers. Currently, there are no prospective studies addressing these issues. Retrospective studies about secondary cytoreduction have reached a certain level. It seems like residual tumor tissue, duration of disease-free survival and recurrence locations in the efficacy of secondary cytoreduction are important parameters in patient selection and survival. There is insufficient study about the efficiacy of tertiary and quarternary cytoreduction surgery. In the few studies available, the main point is tendency to perform an effective surgery that reduce the amount of residual tumor below 0 or 1 cm. But the data presented in all three surgical approaches is highly heterogeneous. Patient numbers, tumor stage and histologic distribution, recurrence distributions, definition of cytoreduction and follow-up time are different. Bias is inevitable within this heterogeneity. As a result, surgeons operate patients with their own capabilities and these patients survive better than patients treated with salvage chemoterapy. Although the prognostic role of maximal cytoreduction is emphasized in all studies, this maximality may have been obtained from biologically more benign tumors. In addition, it does not mention how many patients are left out of work in all studies. Current series do not include surgical experience that change over time, technical infrastructure and chemotherapy protocols. Most of the studies do not focus on which chemotherapy protocols are given in the pre- and postoperative period. Also there are no studies on quality of life. All studies after radical surgery focus on survival rates.Our aim is to evaluate studies on secondary, tertiary, and quarternary cytoreductive surgery, to reveal missing aspects of studies and to contribute future studies.