Surgical standards in the management of ovarian cancer

Surgery is the cornerstone of management of epithelial ovarian cancer and h as broad applications throughout the clinical course of disease, from initi al diagnosis to palliative care. Comprehensive surgical staging is essentia l for precise prognostic determination and treatment planning for patients with apparent early-stage ovarian cancer. Although randomized trials are la cking, the survival advantage associated with optimal primary cytoreduction has been consistent and reproducible. With increasing radicality of cytore ductive surgical techniques and sophistication of postoperative care. it ap pears that an "optimal" surgical procedure is that which leaves the patient with no visible residual disease, The survival benefits of cytoreductive s urgery are also applicable to women with stage IV ovarian cancer, although the rate of success is somewhat attenuated compared with patients with stag e III disease. Recent data also indicate that with appropriate surgical sel ection criteria, secondary cytoreduction is associated with a significant p rolongation of survival for patients with recurrent ovarian cancer. Unfortu nately. several recent publications illustrate how the decentralization of health care may have significant ramifications on the ability of women with known or suspected ovarian cancer to avail themselves of the surgical stan dard of care. Curr Opin Oncol 2000, 12:474-480 (C) 2000 Lippincott Williams & Wilkins, inc.