• Progression-free survival [ Time Frame: Up to 24 months after last patient randomized ]
  from date of randomization until the date of 3rd relapse/progression or death (whatever occurs first)
• Treatment free intervals [ Time Frame: Up to 24 months after last patient randomized ]
  the intervals of the ending date from system anticancer therapy to the starting date of the subsequent anticancer therapy or death
• Overall Survival [ Time Frame: Approximately up to 24 months after last patient randomized ]
  from date of randomization until the date of death from any cause
• 30-day post-operative complications [ Time Frame: From the operation until after 30 days ]
  surgical complications grading criteria will be adopted for evaluating the perioperative complications
• Quality of life assessment [ Time Frame: baseline; 6 and 12 months after randomization ]
  the European Organization for Research and Treatment (EORTC) core quality of life questionnaire (QLQ-C30, version 3.0) The total score (range from 0 to 1,000)

• Progression-free survival [ Time Frame: Up to 24 months after last patient randomized ]
  from date of randomization until the date of 3rd relapse/progression or death (whatever occurs first)
• Treatment free intervals [ Time Frame: Up to 24 months after last patient randomized ]
  the intervals of the ending date from system anticancer therapy to the starting date of the subsequent anticancer therapy or death
• Overall Survival [ Time Frame: Approximately up to 24 months after last patient randomized ]
  from date of randomization until the date of death from any cause
• 30-day post-operative complications [ Time Frame: From the operation until after 30 days ]
  surgical complications grading criteria will be adopted for evaluating the perioperative complications
• Quality of life assessment [ Time Frame: baseline; 6 and 12 months after randomization ]
  the European Organization for Research and Treatment (EORTC) quality of life questionnaires

• Ovarian Cancer Recurrent
• Fallopian Tube Cancer
• Primary Peritoneal Carcinoma

• Procedure: Surgery
  Tumor debulking surgery (surgery in recurrent ovarian disease)
  Other Name: secondary cytoreduction
• Drug: carboplatin/taxane, carboplatin/gemcitabine, cisplatin/gemcitabine, liposome doxorubicin/carboplatin...
  Salvage chemotherapy
  Other Name: third-line therapy
• Drug: Niraparib
  Niraparib maintenance therapy
  Other Name: maintenance therapy

• Experimental: Surgery

  Intervention:

  Procedure: Maximum effort cytoreductive surgery combined with Niraparib maintenance Drug: Platinum-based chemotherapy and Niraparib

  Interventions:

  • Procedure: Surgery
  • Drug: carboplatin/taxane, carboplatin/gemcitabine, cisplatin/gemcitabine, liposome doxorubicin/carboplatin...
  • Drug: Niraparib
• Active Comparator: No surgery
  Intervention: Drug: Platinum-based chemotherapy and Niraparib
  Interventions:

  • Drug: carboplatin/taxane, carboplatin/gemcitabine, cisplatin/gemcitabine, liposome doxorubicin/carboplatin...
  • Drug: Niraparib

Inclusion Criteria:

• Age ≥18 years to ≤ 75 years
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2
• Patients with platinum-sensitive, secondary relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer, which is defined as those with platinum-free interval of 6 months or more.
• Front-line or second-line treatment may have included maintenance therapy
• Never received secondary cytoreductive surgery when recurrence
• Assessed by the experienced surgeons, complete resection of all recurrent disease is possible. Single or localized lesions identified by CT, or MRI, or positron emission tomography/computed tomography (PET/CT). PI and Co-PI reach consensus if extensive lesions or carcinomatosis.
• It can be included if single lesion outside the peritoneal cavity can be resected.
• No more than 3 disease lesions by central-reviewed PET/CT imaging if the participated center has never participated in any surgical trials on ovarian cancer before.
• Patients who have given their signed and written informed consent and their consent.

Exclusion Criteria:

• Patients with borderline tumors as well as non-epithelial tumors.
• Patients for interval-debulking, or for second-look surgery, or palliative surgery planned.
• Patients whom have already undergone secondary cytoreduction for recurrent disease are excluded.
• Impossible to assess the resectability. Radiological signs suggesting complete resection is impossible.
• Patients who have received more than two previous regimen of chemotherapy (maintenance is not considered a third regimen).
• Third relapse or more.
• Patients with second or other malignancies who have been treated by surgery, if the treatment might interfere with the treatment of relapsed ovarian cancer or if major impact on prognosis is expected.
• Progression during chemotherapy or recurrence within 6 months after second-line platinum-based therapy
• Any contradiction not allowing surgery and/or chemotherapy and/or or Niraparib
• Accompanied by hypoxia serious chronic obstructive pulmonary disease
• Uncontrolled hypertension, cerebrovascular accident/ Stroke, myocardial infarct, unstable angina, untreated thrombosis, chronic congestive heart failure, or serious arrhythmia in need of medicine.
• Severe hepatitis, history of liver disease, nephrotic syndrome, renal insufficiency
• Active ulcer history, abdominal wall fistula, perforation of gastrointestinal tract, or Intra-abdominal abscess, or simultaneously apply treatment/prevent ulcers therapy.
• Uncontrolled diabetes
• Uncontrolled epilepsy need long-term antiepileptic treatment.
• Any medication induced considerable risk of surgery, e.g. estimated bleeding due to oral anticoagulating agents.
• ≥3 grade anemia, neutropenia or thrombocytopenia due to chemotherapy, and lasted for more than 4 weeks
• Patients with a known hypersensitivity to Niraparib or any of the excipients of the product.

• Fudan University
• Shanghai Jiao Tong University School of Medicine
• Zhejiang Cancer Hospital
• Sun Yat-sen University