Cytoreductive surgery for advanced stages of ovarian cancer

Abstract

During the past two decades, maximum cytoreductive surgery (also called debulking surgery) has been the recommended surgical approach for advanced stages of ovarian carcinoma. The residual tumor volume after surgery is one of the strongest prognostic factors, and only patients who undergo complete or optimal surgery are likely to be long‐term survivors (i.e., 50% after five years). A well‐trained surgeon in the field of gynecologic oncology can achieve an optimal tumor reduction in up to 75% of patients with advanced stage ovarian cancer. During the procedure, bowel resection, especially rectosigmoid, must be undertaken in 30% to 40% of cases, and para‐aortic and pelvic lymphadenectomy should be performed after adequate tumor reduction in the abdominal cavity. The experienced surgeon can perform these surgeries with an acceptable morbidity, allowing chemotherapy to be undertaken within the month following surgery. However, very advanced cancer with massive peritoneal carcinomatosis and/or Stage IV disease requires a very aggressive surgical procedure but yields a poor prognosis and a higher risk of unacceptable complications. For these worst cases, the concept of cytoreductive surgery is moving toward the alternative strategy of chemosurgical cytoreduction, in which interval cytoreductive surgery is undertaken after three cycles of front‐line chemotherapy. The goal of this experimental strategy is to achieve a complete tumor response after front‐line chemosurgical therapy, and a better quality of life. Semin. Surg. Oncol. 19:42–48, 2000. © 2000 Wiley‐Liss, Inc.

Importance of the development time of isolated bone metastasis in breast cancer

“…Systemic therapies are more likely to be effective after maximal tumor debulking because, with a given cell kill rate, fewer cells will survive, and evolution of resistant cells will be less probable [16,17]. For this reason and also to control the disease locally, mastectomy was performed in the antracycline-resistant eight patients in the synchronous group.…”

Primary debulking surgery vs. neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

“…Multiple studies suggested that patients of advanced ovarian cancer treated with NAC improved performance status, decreased the extent and morbidity of surgery, and increased the opportunity of optimal debulking surgery [2,[4][5][6][7][8][10][11][12]. Therefore, it is natural to consider NAC followed by IDS to be an alternative to conventional PDS in treating advanced ovarian cancer and expect that the NAC group would have better survival than PDS group.…”

“…Disappointingly, optimal debulking can be achieved in only 30-60 % of stage III/IV ovarian cancers [2]. Most patients diagnosed with advanced ovarian cancer are elderly, with multiple comorbidities.…”

Comparison of Platinum-based Neoadjuvant Chemotherapy and Primary Debulking Surgery in Patients with Advanced Ovarian Cancer

“…Patients with advanced ovarian cancer are usually low candidates for primary surgery due to massive ascites, pleural effusion, and large abdominal tumor. In these patients, sometimes the tumor is unresectable [8][9][10].…”