Secondary surgery in patients with serous low malignant potential ovarian tumors with peritoneal implants

Objective: To determine the impact of secondary surgery in patients treated for a serous low malignant potential ovarian tumor (LMPOT) and peritoneal implants. Methods: A retrospective review of patients with a serous LMPOT and peritoneal implants treated in or referred to our institution. The characteristics of patients who had undergone surgery were compared with those who had not. We analyzed the clinical impact of this procedure. Results: From 1969 to 2006, 171 patients were reviewed. Secondary surgery was defined as classic second-look surgery (residual disease at the time of initial surgery, a different histological analysis between the initial and definitive diagnosis) and surgery for abnormal radiological findings during follow-up. Fifty-seven patients had undergone secondary surgery (which was positive in 16 of them). The percentages of patients with residual disease and invasive implants at the time of initial management who had received adjuvant therapy were higher among subjects who had undergone secondary surgery. The recurrence-free interval between patients in whom secondary surgery was negative and in patients who had not undergone a secondary procedure was statistically different. Four factors were predictive of recurrent disease: the use of conservative surgery, the use of laparoscopic surgery, the presence of residual disease at the end of surgery, and positive secondary surgery. Conclusions: Secondary surgery seems to reduce the risk of recurrence in patients with serous LMPOT and peritoneal implants. Patients with residual disease are probably those likely to benefit from such surgery. Further studies are needed to confirm these preliminary results.