Cytoreductive surgery for advanced stages of ovarian cancer

During the past two decades, maximum cytoreductive surgery (also called deb ulking surgery) has been the recommended surgical approach for advanced sta ges of ovarian carcinoma. The residual tumor volume after surgery is one of the strongest prognostic factors, and only patients who undergo complete o r optimal surgery are likely to be long-term survivors (i.e., 50% after fiv e years). A well-trained surgeon in the field of gynecologic oncology can a chieve an optimal tumor reduction in up to 75% of patients with advanced st age ovarian cancer. During the procedure, bowel resection, especially recto sigmoid, must be undertaken in 30% to 40% of cases, and para-aortic and pel vic lymphadenectomy should be performed after adequate tumor reduction in t he abdominal cavity. The experienced surgeon can perform these surgeries wi th an acceptable morbidity, allowing chemotherapy to be undertaken within t he month following surgery. However, very advanced cancer with massive peri toneal carcinomatosis and/or Stage IV disease requires a very aggressive su rgical procedure but yields a poor prognosis and a higher risk of unaccepta ble complications. For these worst cases, the concept of cytoreductive surg ery is moving toward the alternative strategy of chemosurgical cytoreductio n, in which interval cytoreductive surgery is undertaken after three cycles of front-line chemotherapy. The goal of this experimental strategy is to a chieve a complete tumor response after front-line chemosurgical therapy, an d a better quality of life. Semin. Surg. Oncol. 19:42-48, 2000. (C) 2000 Wi ley-Liss, Inc.