The role of surgery in advanced epithelial ovarian cancer

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.

CD44 Regulates Formation of Spheroids and Controls Organ-Specific Metastatic Colonization in Epithelial Ovarian Carcinoma

“…S9). Most medically fit patients undergo salpingo-oophorectomy in the process of debulking surgery (44), thus more aggressive behavior of spheroids during recolonization would only affect those who did not undergo debulking surgery. The omentum may be partially or completely surgically resected depending on the degree of its involvement with metastasis; however, when the omentum is tumor free, typically, it is not surgically removed (45).…”

Prognostic value of lymphocyte-to-monocyte ratio in ovarian cancer: a meta-analysis

“…Despite advances in early diagnosis and targeted drug treatment, as well as improvements in drug cytotoxicity, most patients are still diagnosed at an advanced stage [2, 3]. Furthermore, chemotherapy is frequently not effective in controlling the disease mainly due to the development of primary or secondary resistance to anticancer drugs.…”

Crizotinib and PARP inhibitors act synergistically by triggering apoptosis in high-grade serous ovarian cancer

“…With a relative five-year survival less than 50%, it is the fifth most common cause of cancer-related deaths [1, 2]. Cytoreductive surgery and post-operative platinum-based chemotherapy are the standard treatments for patients diagnosed with advanced-stage disease [3–5]. Due to the poor prognosis, associated with a high recurrence rate of >75%, it is vital to investigate new treatment strategies [3].…”