Beyond Quaternary Cytoreduction for Recurrent Ovarian Cancer

Introduction Even in the case of recurrent ovarian neoplasms, the most effective way to improve the prognosis of these patients seems to be repeated cytoreduction. Material and method We present a series of four patients diagnosed with the fifth recurrence of ovarian origin and who underwent cytoreduction with maximum intent. Results and conclusions Maximal cytoreduction (defined by the absence of macroscopically visible residual tumour volume) was feasible in three cases, while in the fourth case the cytoreduction was considered suboptimal (because of the presence of carcinomatosis nodes that invaded the liver pedicle). The main visceral resections performed at this time consisted of splenectomy in two cases, distal pancreatectomy in one case, atypical hepatectomy in two cases, segmental enterectomies in three cases, parcelar gastrectomies in two cases and transversal colectomy in one case respectively. Postoperatively, one case required reintervention for early postoperative hemoperitoneum. In conclusion, debulking beyond quaternary cytoreduction can be feasible and can provide adequate clearance of residual tumours, thus improving the long-term prognosis of these patients.