Surgical techniques for cytoreduction in advanced ovarian malignancy

Abstract

Surgical techniques for cytoreduction in advanced ovarian malignancy To the Editors: I read with great interest the article by Rose (Rose PG. The cavitational ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer. Al J OBSTH GYNECOL 1992 ;166:843-6). Rose reponed that using the cavitational ultrasonic aspirator he was able to effectively achieve an optimal cytoreduction in 48% of patients (22 of 45 patients) ; this is without a doubt a low percentage when it is considered that the volume of postoperative residual disease significantly affects patient survival. Rose also reported that in 29 sites in which he used this technique he was not able to achieve an optimal cytoreduction and other extensive surgical procedures had to be used. Therefore it appears that this technique is of limited value, especially in removing dense fibrous tumor; this view is supported by Deppe et al. I From my experience and the experience of others, 3 it appears that electrosurgical debulking with an argon beam coagulator is a far more superior technique. The argon beam coagulator allows better visibility, hemostasis, and tumor destruction. With this technique tumors in inaccessible sites such as the diaphragm, stomach, duodenum, and liver capsule could be debulked. The argon beam coagulator can be used for larger surface areas and areas with limited tolerance to injury. I believe that the argon beam coagulator is more effective in achieving optimal cytoreduction « 0.5 em) than the neodymium-yttrium aluminum garnet (Nd:YAG) surgical laser and the Cavitron ultrasonic surgical aspirator. In conclusion, the efficacy of this modality of cytoreduction needs to be investigated further. Prospective randomized study and analysis of long-term follow-up in comparison with other methods are needed toevaluate the effectiveness of the cavitational ultrasonic aspirator. Samir A. Farghaly, MD, PhD Albert Einstein College of Medicine, Room 421, Ullman Research Bldg., 1300 Morris Park Ave., New York, NY 10461