Current Status of Primary Cytoreductive Surgery for the Treatment of Advanced Epithelial Ovarian Cancer

Kaei      Nasu; Harunobu      Matsumoto; Noriyuki      Takai; Hisashi      Narahara

Abstract

Ovarian cancer is the third-most common cancer of the female reproductive tract, yet it has the highest case fatality ratio of all gynecologic malignancies. Approximately 60% of women diagnosed with epithelial ovarian cancer will die of the disease, because the majority of patients are diagnosed with advanced disease. Surgery followed by chemotherapy is the standard approach to the management of advanced epithelial ovarian cancer. The goal of the surgery is optimal cytoreduction prior to the initiation of chemotherapy. As significant survival benefit from optimal cytoreduction has also been shown for patients with advanced disease. The generally accepted definition of optimal cytoreduction today is a residual tumor diameter no greater than 1 cm. However, the surgeon should attempt to achieve complete cytoreduction to a level of no visible disease or microscopic disease. The surgical procedures required to achieve complete cytoreduction depend on the disease distribution. The most common areas of tumor involvement are the paracolic gutters, the small bowel serosal and mesentery surfaces, the diaphragmatic and pelvic peritoneum, the greater and lesser omentum with extension to the transverse colon, and the sigmoid colon affected by direct extension from the ovary. In cases of extensive tumor involvement, optimal cytoreduction may involve a radical en bloc resection of all involved pelvic viscera and associated peritoneum, bowel resection, splenectomy, and diaphragmatic and liver resection. The benefit of such aggressive surgery outweighs the risk of morbidity in the vast majority of patients. This paper is a review of the recent information concerning the definition of optimal cytoreduction, surgical techniques for maximum cytoreduction, and the selection criteria for patients.

Keywords: Epithelial ovarian cancer, advanced stage, primary cytoreductive surgery, optimal cytoreduction

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