Advanced Cytoreductive Surgery Research Articles

Transforming the Future of Treatment for Ovarian Cancer

As for many other cancers, metastasis is the leading cause of death of patients with ovarian cancer. Vigorous basic and clinical research is being performed to initiate more efficacious treatment strategies to improve the poor outcome of women with this cancer. Current treatment for ovarian cancer includes advanced cyto-reductive surgery and traditional platinum and taxane combined chemotherapy. Clinical trials using novel cytotoxic reagents and tyrosine kinase inhibitors have also been progressing. In parallel, the application of robust unbiased high throughput research platforms using transcriptomic and proteomic approaches has identified that not only individual cell signalling pathways, but a network of molecular pathways, play an important role in the biology of ovarian cancer. Furthermore, intensive genomic and epigenetic analyses have also revealed single nucleotide polymorphisms associated with risk and/or aetiology of this cancer including patient response to treatment. Taken together, these approaches, that are advancing our understanding, will have an impact on the generation of new therapeutic approaches and strategies for improving the outcome and quality of life of patients with ovarian cancer in the near future.

Advanced cytoreductive surgery: Asia Pacific perspective

The thoroughness of cytoreductive surgery is the largest contributor to survival for patients with advanced ovarian and primary peritoneal carcinoma. For many years the surgery undertaken by Gynaecologic Oncologists has been tailored to match their surgical training. Future surgical training of Gynaecologic Oncologists needs to be tailored to the surgery required to provide complete tumour removal to no residual disease. This means the better teaching of anatomy and an increased scope of surgery to include the general and upper abdominal procedures and management required. This paradigm shift will be a challenge for all and impossible for some. It will require a significant mind-shift not only from our craft group and the profession at large but especially from the speciality Colleges who will need to take these changes on board for future curriculum development. The development of Advanced Cytoreductive Surgical Units needs to be undertaken in a team environment. This requires a commitment from participants at all levels, from the lead oncology surgeon through the hospital administration to the support services involved. While advanced cytoreductive surgery is feasible, it is only in this team environment, limited to major multidisciplinary hospitals, that it can be safely achieved by meticulous attention to detail at all levels.

Advanced cytoreductive surgery: American perspective

Over the past 3 to 4 decades a special knowledge and understanding of the pathophysiology and behavior of gynecologic peritoneal surface malignancies has led to a significant improvement of the relevant treatment modalities, mirroring advances in chemotherapy approaches and improved knowledge of tumor biology. The surgical management of advanced ovarian, primary peritoneal, and fallopian tube cancers has evolved from the performance of basic gynecologic procedures to the incorporation of more comprehensive surgical procedures. This extensive surgical approach is of great importance for estimating the prognosis and guiding further treatment of affected patients. These complex procedures involving multi-organ resections are generally long and require excellent knowledge of upper abdominal anatomy. This article will focus on the role and program development of advanced cytoreductive surgery in patients with gynecologic peritoneal malignancies. This review is an attempt to provide guidance for the rationale and strategic approach to develop the surgical skill set, meet institutional requirements, and implement the concept of a comprehensive cytoreductive surgical team.