Surgical management of ovarian cancer

ABSTRACT

Ovarian cancer is the most lethal of the gynecologic cancers worldwide because most patients present with advanced stage disease at the time of diagnosis. Although multiple therapeutic modalities are employed in the management of ovarian cancer, and despite advances in chemotherapeutic and biologic agents, primary surgery followed by adjuvant chemotherapy remains the cornerstone treatment of this disease. Adequate, comprehensive surgical staging in women with early stage ovarian cancer has been shown to improve oncologic outcomes. Complete surgical cytoreduction leaving no gross residual disease is known to be the only physician-driven prognostic factor for patients with advanced disease. This review describes the rationale and surgical steps for full surgical staging for women with early ovarian cancer, and outlines the cytoreductive surgical procedures required to achieve optimal cytoreduction in patients with advanced ovarian cancer. In addition, the impact of radical surgery (as part of maximal tumor debulking) on the amount of residual tumor and on survival rates will be discussed.