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284 Morbidity and mortality associated with cytoreductive surgery in primary and recurrent ovarian malignancy: a meta-analysis

Objectives To compare morbidity and mortality in patients with advanced ovarian cancer undergoing cytoreductive surgery (CRS) for primary and recurrent disease. Methods A literature search was performed for publications reporting morbidity and mortality in patients undergoing CRS in primary and recurrent ovarian malignancy. Two independent reviewers applied inclusion and exclusion criteria to select included papers. A total of 215 citations were reviewed; 6 studies comprising 641 patients were selected for the analysis. Literature search was performed using PRISMA guidelines. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Results The overall morbidity rate was 38.4%, and this did not differ between the two groups (p=0.97). This did not change when only Clavien-Dindo grade 3 and 4 morbidities were accounted for (14% primary CRS, 15% recurrent, p=0.83). Compared to primary CRS, secondary CRS was associated with a similar operative time (mean 400 minutes, I2=79%, p=0.45), rate of bowel resection (I2=75%, p=0.37) and transfusion requirements (MD -0.7L, I2=76%, p=0.45). The rate of complete (R0) resection was 69.4%, with no significant difference between primary and recurrent disease (p=0.46). Although all studies commented on postoperative mortality, there were too few deaths in either group to allow meaningful meta-analysis, with 4 deaths in the group undergoing primary CRS (1.0%) and 2 deaths in the group with recurrent disease (0.9%). Conclusions Secondary CRS for recurrent ovarian cancer is a safe and feasible option in carefully pre-selected patients with comparable morbidity and survival outcomes to primary CRS.