Surgical staging and cytoreductive surgery of epithelial ovarian cancer

Abstract

Surgery remains the cornerstone of the treatment for epithelial ovarian cancer. In early ovarian cancer, the initial operation is a complete assessment of the spread of disease. In this staging operation, 33% of patients thought to have either Stage I or II tumors will be found to have advanced-stage disease. The correct diagnosis of advanced disease prevents improper treatment of patients originally thought to have early disease. For patients with advanced disease, the initial cytoreductive operation reduces tumor bulk and produces increased sensitivity to chemotherapy for the remaining tumor. The principles of cellular kinetics provide good theoretic evidence for the benefit of cytoreductive surgery. Current studies relating to primary and secondary surgical cytoreduction of epithelial ovarian cancer were reviewed. Current indirect evidence indicates a significant survival benefit for patients with epithelial ovarian cancer who undergo successful surgical cytoreduction. Several recent studies also have shown the importance of the biology of the tumor, the extent of tumor spread, the location of the tumor, the cell type, the histologic grade, and the age of the patient. Although the literature contains fewer reports of secondary cytoreductive surgery than of primary cytoreductive surgery at the time of second-look, surgical reassessment appears to provide a survival benefit. The potential benefit of secondary cytoreduction will be increasingly important as new salvage therapies become available.