How to improve the optimal cytoreductive surgery in advanced ovarian carcinoma

Abstract

Advanced ovarian carcinoma is a lethal tumour, and its standard treatment is consists of aggressive primary cytoreductive surgery followed by a chemoadjuvance based on platinum agents. We searched the Cochrane Gynaecological Cancer Group Trials Register of 2010, Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE of 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. One of the goals of its management is to achieve the longest overall survival possible, and the most important survival factor is the residual tumour after cytoreductive surgery, obtaining the best surveillance in the cases where no tumour is left in the abdomen. To improve the cytoreductive rates in the actual management strategy, a change is necessary, selecting the cases not suitable for primary debulking surgery and adding, if necessary, procedures different than the ovarian tumour resection, like bowel resections, peritonectomies (particularly diaphragmatic ones) and splenectomies. This review pretends to understand why advanced ovarian carcinoma should be treated with primary surgery whenever possible and to rationate the use of extrapelvic surgical procedures. The improvement of surgical rates with these manoeuvres can determine the best management of our patients, without clinical complications.

Clinical Outcome After Completion Surgery in Patients With Ovarian Cancer: The Charite Experience

“…32,33 Our findings highlight that incomplete surgical staging increases the probability of hidden occult cancer in the peritoneal cavity with respect to inferior outcome. Therefore, the best strategy currently available for improving OS appears to be, first, the consistent referral of affected patients to those expert centers demonstrating institutional compliance with recommended treatment guidelines and, second, having an experienced, coordinated multidisciplinary team for the initial surgery.…”

Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery

“…However, fluid accumulation occurs in the pouch due to gravity, as it is one of the posterior spaces in the peritoneal cavity. For this reason, Morison's pouch is one of the most affected anatomical zones in AEOC [9,[53][54][55]. It is also a frequent site for OC recurrences [55].…”

“…For this reason, Morison's pouch is one of the most affected anatomical zones in AEOC [9,[53][54][55]. It is also a frequent site for OC recurrences [55]. However, the percentage of Morison's pouch metastases in AEOC has not been estimated in the literature, as it is actually an upper abdomen metastatic peritoneal involvement.…”

Current South African clinical Practice in Debulking Surgery for Ovarian Cancer

“…Lastly, it may also improve immune competence of the patient (host). 4,10 The definition of optimal debulking and also the rate at which it is achieved varies among surgeons and within units. 11 The gynecologic oncology group defines optimal cytoreduction as residual disease less than 1 cm in maximal tumor diameter.…”

“…The gynecological oncologists' approach to debulking surgery is more aggressive and therefore better outcomes can be achieved. 10,14,20 Gynecological oncology was registered as a subspecialty in South Africa in 2006, and the training for gynecological oncologists consists of a 2-year subspecialty fellowship program in an accredited training center. These surgeons practice in both public and private hospitals, common also with outreach surgery to rural areas.…”