Ovarian Cancer Surgery

Surgery is crucial in Ovarian Cancer treatment and should be performed by specialists. Primary treatment of Ovarian Cancer is largely surgery-based, and studies have shown that optimal surgery can significantly increase survival rates (37 vs 17 months) and complete response to chemotherapy (50% vs 20%). It is also reported that survival is dependent on
the expertise and degree of specialization of the surgeon, with a 25% improvement in 3-year survival among patients whose ovarian tumors are removed by a specialized gynecologist. Nevertheless, often times neither surgery nor staging are optimal, rendering the interpretation of some studies difficult. Chemotherapy is currently given after surgical resection of the tumor has been performed, and replacing surgery with chemotherapy is not recommended. However, several clinical trials based around new treatment strategies are currently underway, and these may well offer an alternative approach to therapy in the future.
Designing clinical trials of new drug combinations for OC is complicated by the great heterogeneity of patients with this disease. In 2004, the 3rd International OCCC made a number of recommendations regarding the extent of surgery for patients taking part in first-line chemotherapy trials. Staging should be performed according to FIGO guidelines. For example, this includes at least lymph node sampling and peritoneal staging in early-stage invasive disease (FIGO I–IIA). Up-front maximal surgical effort at cytoreduction with the goal of no residual disease should be undertaken. Conservative surgery should only be considered in
specific cases like well-differentiated (grade 1) stage IA, young patient with low parity, and ability for close follow-up. The role of cytoreductive surgery (CS) in recurrent ovarian cancer (ROC) has not been clearly defined.