Background/Objective: Platinum-resistant ovarian cancer (PROC) has limited therapeutic options, and the role of cytoreductive surgery (CRS) in improving survival outcomes remains uncertain. We performed a systematic review to evaluate the oncological benefit of CRS on PROC patients and the associated surgical morbidity and mortality. Methods: We followed a prospective protocol according to PRISMA guidelines. We searched PubMed, Medline, and Embase till October 2024. We used a “Population Intervention Comparator Outcomes (PICO)” framework. Our population included women with epithelial PROC who underwent CRS with/without chemotherapy. Our outcomes included overall survival (OS), progression-free-survival (PFS), post-operative morbidity and mortality and Quality of Life. Results: Our search yielded 6590 citations; six studies (N = 155 patients) were included. There is limited evidence available on the role of CRS in PROC, with notable variation in reported outcomes and outcomes’ measures; therefore, we were unable to perform quantitative synthesis. CRS demonstrated survival benefits in well-selected PROC patients, particularly those with limited, isolated recurrences, low tumour burden, and good performance status. Complete resection (R0) was associated with significantly longer OS/PFS compared to those who had suboptimal surgeries (R1/R2). Conclusions: CRS seems to extend survival in carefully selected PROC patients, especially those with limited disease spread and favourable surgical profiles. Nevertheless, CRS carries substantial surgical risks, and its benefits appear contingent upon achieving R0. Further prospective trials with standardised patient selection criteria are needed to define CRS’s role in PROC. At present, CRS in PROC should be considered within a multidisciplinary approach in specialised gynaecological oncology centres, with the careful assessment of patient-specific risk factors and potential for R0 resection.

Introduction and relevance: Paraneoplastic hyponatremia is often secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) by tumour cells. Immature ovarian teratomas (IOT) are uncommon and may present with SIADH. Case report: A 26-year-old female presented with a 3-month history of abdominal pain and constipation. Imaging identified a mixed solid-cystic right ovarian mass containing fat and peritoneal deposits. Biochemistry showed severe, refractory hyponatremia (117 mmol/l). She underwent diagnostic fertility-preserving right salpingo-oophorectomy and resection of peritoneal nodules with the aim to achieve symptom control and hyponatraemia resolution. Pathology revealed a FIGO Stage 2 Grade 2 IOT with extensive benign peritoneal gliomatosis. Initial management was conservative. After 6 months of active follow-up, a rise in AFP, and recurrent hyponatremia supported the decision to administer three cycles of Bleomycin-Etoposide-Cisplatin chemotherapy. One month later, given radiological disease progression despite satisfactory biomarker response, cytoreductive surgery with complete macroscopic resection was performed. Pathology consisted solely of peritoneal mature glial elements: a growing teratoma syndrome (GTS). The patient remains disease-free after 2 years of surveillance. Clinical discussion: Specimen histological assessment from the patient’s initial surgery showed immature neuroectodermal tubules, which are thought to be the source of vasopressin secretion. The authors hypothesise that recurrent hyponatremia and rising AFP levels represented postoperative disease relapse. Biochemical response despite radiological disease progression was pathognomonic of a GTS. Conclusion: Paraneoplastic SIADH secondary to an IOT must be considered in female patients presenting with abdominal symptoms and hyponatremia. Management requires a multidisciplinary approach. Serum electrolytes are useful surveillance biomarkers supplementary to tumour markers.

Background/Objectives: We evaluated perioperative morbidity, recurrence patterns and survival outcomes following pelvic exenteration (PE) at a tertiary referral centre. Methods: A retrospective observational study was conducted in women undergoing PE from 2004 to 2024. We collected demographics, performance status (PS), comorbidities, body mass index (BMI), tumour histology, intraoperative details, postoperative morbidity (Clavien–Dindo classification), mortality, length of stay (LOS), recurrence patterns and cancer-related death. Descriptive statistics were performed alongside Kaplan–Meier survival analysis. Results: Forty-seven patients underwent PE; median PS was 0 [interquartile range (IQR) 0–0]. Median ages at diagnosis and surgery were 55 (IQR 49–66) and 60 (IQR 50–68) years, respectively, with a median follow-up of 26 months (IQR 12–64). Thirty-two procedures (68%) were performed for recurrent and N = 15 (32%) for primary disease. Histology included N = 17 endometrial (36%), N = 10 vulval (23%), ovarian (15%), N = 5 cervical (11%) and N = 7 vaginal (15%) cases. Eighteen patients (38%) underwent total PE, N = 15 (32%) anterior PE and N = 14 (30%) posterior PE. Median blood loss was 1.5 L (IQR 0.85–2.0) and median operative time was 391 mis (IQR 313–482). Median HDU stay was 4 days (IQR 2–5) and LOS was 17 days (IQR 13–31). One postoperative death occurred. Major complications (Clavien–Dindo ≥3) occurred in 15 patients (32%). Late complications occurred in n = 17 (36.2%) women. Nineteen patients (41%) remained recurrence-free; N = 4 (9%) developed local and N = 24 (51%) distant recurrence. Mean overall survival time post-surgery for curative intent PE (N = 46) was 94 months (95%CI = 57–131 months); for primary tumours this was 51.6 (95%CI = 31–72) vs. 99 (56.01–142) for recurrent disease (p > 0.05). Conclusions: Pelvic exenteration is associated with acceptable morbidity and mortality in carefully selected patients, offering excellent locoregional disease control.