ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

The role of quaternary cytoreduction in relapsed ovarian cancer – a systematic review



Introduction. Ovarian cancer is characterized by a high capacity of relapse, even in cases in whom cytoreductive surgery with curative intent followed by platinum and taxanes-based chemotherapy were performed. In such cases, attention was focused on determining if iterative cytoreduction might improve the long-term outcomes and how far these boundaries can be pushed. While for secondary cytoreduction multiple studies have been conducted, for tertiary and quaternary cytoreduction data are significantly scarcer.

The objective of the study. This paper aims to realize a systematic review of the studies published so far on the theme of quaternary cytoreduction.

Methodology. We searched medical journals in English language published from January 2010 to December 2019.

Results. Six studies involving 110 patients submitted to quaternary cytoreduction met the inclusion criteria. Data reported in the above mentioned studies demonstrate that quaternary cytoreduction can be safely performed both at the level of the lower and the upper abdomen, in order to maximize the debulking effort. However, a significantly lower number of cases will be considered candidates for this type of procedure, when compared to secondary or even tertiary cytoreduction, an adequate selection process being mandatory in order to minimize the postoperative risks.

Conclusions. Although it is less frequently feasible when compared to secondary or tertiary cytoreduction, quaternary cytoreduction might be beneficial in selected cases.

Keywords: quaternary, debulking, ovarian cancer, survival.

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Address for correspondence:
„Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania
Email:; Phone +40 723 540 426


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Bacalbasa N, Balescu I, Vilcu M, Halmaciu I, Diaconu CC, Dima S, Brezean I. The role of quaternary cytoreduction in relapsed ovarian cancer – a systematic review. Arch Balk Med Union. 2020;55(2):298-303.