INITIAL SURGERY FOR ADVANCED EPITHELIAL O VARIAN-CANCER

Epithelial ovarian cancer is usually diagnosed at an advanced stage wi th a bulky tumor in the pelvis and upper abdomen. The most common ther apeutic strategy begins by a surgical operation that allows histologic diagnosis, accurate staging and maximal debulking. Since the papers b y Griffiths at the end of the seventies, the volume of the residual tu mor after surgery appears to be one of the most important prognostic f actors in all series. Indeed, patients whose tumor is completely or op timally debulked have greater chances of prolonged survival of about 5 0% at 5 years. Surgeons experienced in this field can achieve optimal debulking in about 75 to 80% of cases. But, in order to reach this obj ective, they must often perform an ultraradical operation with extensi ve peritonectomies, lymphadenectomies and intestinal resections. Moreo ver, since 1983, Hacker has shown that the initial tumor bulk was stil l a poor prognostic factor even after debulking. Today it can be demon strated that the greater the tumor bulk the more aggressive must be th e surgical procedure in order to be optimal and the final benefit will nevertheless be proportionally lower with a higher morbidity rate. Th is paradigm leads the surgeons to currently try to more accurately ass ess the initial tumor bulk in order to determine wether the tumor woul d be optimally debulked by means of a well-standardised operation. If not, the alternative strategy would be 3 chemotherapy courses as front -line treatment before debulking surgery, which hopefully would be eas ier. Trials are needed in order to validate this strategy despite the fact that some patients will unfortunately have their prognosis jeopar dized by the chemoresistance of their tumor.