Abstract
Nowadays, the standard management of advanced epithelial ovarian cancer is correct surgical staging and optimal tumour cytoreduction followed by platinum and taxane-based chemotherapy. Standard surgical staging consists of peritoneal washings, total hysterectomy, and bilateral salpingo-oophorectomy, inspection of all abdominal organs and the peritoneal surface, biopsies of suspicious areas or randomised biopsies if they are not present, omentectomy and para-aortic lymphadenectomy. After this complete surgical staging, the International Federation of Gynaecology and Obstetrics (FIGO) staging system for ovarian cancer is applied to determine the management and prognosis of the patient. Complete tumour cytoreduction has shown an improvement in survival. There are some criteria to predict cytoreduction outcomes based on serum biomarkers levels, preoperative imaging techniques, and laparoscopic-based scores. Optimised patient selection for primary cytoreduction would determine patients who could benefit from an optimal cytoreduction and might benefit from interval surgery. The administration of intraperitoneal chemotherapy after debulking surgery has shown an increase in progression-free survival and overall survival, especially in patients with no residual disease after surgery. It is considered that 3–17% of all epithelial ovarian carcinoma (EOC) occur in young women that have not fulfilled their reproductive desires. In these patients, fertility-sparing surgery is a worthy option in early ovarian cancer.
Highlights
Ovarian cancer is the seventh most common cancer and the eighth cause of death from cancer among women worldwide (3.6% of cases and 4.6 % of deaths) [1]
Prophylactic bilateral salpingo-oophorectomy could result in an 80% risk reduction of developing ovarian cancer among these patients [4]
This study showed the importance of complete secondary cytoreduction surgery, with a better survival rate in patients with complete resection than in patients who underwent incomplete secondary cytoreductive surgery
Summary
Ovarian cancer is the seventh most common cancer and the eighth cause of death from cancer among women worldwide (3.6% of cases and 4.6 % of deaths) [1]. Some patients with advanced epithelial ovarian cancer undergo debulking surgery, but complete cytoreduction is not achieved This leads to an increase in morbidity with no improvement in overall survival. The ROVAR score [47] includes four variables and is designed for predicting recurrence after primary treatment with surgical cytoreduction and platinum-based chemotherapy This four variables are tumour stage at diagnosis, tumour grade at diagnosis, CA 125 serum levels at diagnosis and the presence of residual disease on CT scan after chemotherapy treatment. A randomised study [23] with 550 patients with advance ovarian carcinoma, in whom primary cytoreduction was considered to be maximal, did not show an improvement in progression-free-survival or overall survival auditioning secondary cytoreductive surgery to post-operative chemotherapy with paclitaxel plus cisplatin. Antibody-based tumour vaccines and cytokine-based therapies have verified an improvement in host immune activity in order to eradicate cancer cells [60,61]
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