The aim of this study was to determine prognostic factors of patients with advanced ovarian carcinoma who were not successfully cytoreduced at first surgery. Twenty patients with incomplete initial cytoreduction surgery (12 patients with stage IIIc and 8 patients with stage IV), were analyzed for prognostic factors. The survival time of 13 patients with second reduction surgery (SRS) was significantly (P<0.005) longer than that of 7 patients in whom SRS was not applicable. According to the histologic types, the survival time of patients with serous cystadenocarcinoma or endometrioid adenocarcinoma was significantly (P<0.0001) longer than that of patients with clear cell carcinoma, mucinous cystadenocarcinoma or undifferentiated carcinoma. Size of residual tumor after SRS was correlated with response to combination chemotherapy consisting of cyclophosphamide, epirubicine and cis-diamminedichloroplatinum (II) (CAP therapy). The survival time of patients with less than 2 cm residual tumor after SRS was significantly (P<0.05) longer than that of patients with 2 cm or more residual tumor after SRS. Patients in whom CA125 normalized in response to CAP therapy after first surgery had less than 2 cm residual tumor after SRS and survived longer, compared to patients in whom CA125 did not normalize. These results suggest that even if initial cytoreduction surgery failed, patients with good response to CAP therapy and less than 2 cm residual tumor after SRS can be expected to have relatively good prognosis.

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