Maximal cytoreductive effort in epithelial ovarian cancer surgery

Abstract

The surgical management of advanced epithelial ovarian cancer involves cytoreduction, or removal of grossly-evident tumor. Residual disease after surgical cytoreduction of ovarian cancer has been shown to be strongly associated with survival. The goal of surgery is "optimal" surgical cytoreduction, which is generally defined as residual disease of 1 cm or less. However, the designation of "optimal" surgical cytoreduction has evolved to include maximal surgical effort and no gross residual disease. In order to achieve this, more aggressive surgical procedures such as rectosigmoidectomy, diaphragm peritonectomy, partial liver resection, and video-assisted thoracic surgery are reported and increasingly utilized in the surgical management of advanced ovarian cancer. The role of maximal surgical effort also extends to the recurrent setting where the goal of surgery should be complete cytoreduction. Patient selection is important in identifying appropriate candidates for surgical cytoreduction in the recurrent setting. The purpose of this article is to review the role of maximum surgical effort in primary and recurrent ovarian cancer.

The causes, diagnosis, and treatment of recurrent ovarian cancer. A literature review and analysis of the authors’ data

“…На вероятность возникновения рецидива заболева-ния влияет интраоперационное выявление макроскопи-ческих изменений: прорастание опухоли в капсулу кисто-мы или наличие опухолевых клеток в асците, нарушение целостности капсулы опухоли при хирургических мани-пуляциях, массивные сращения и спайки опухоли с окру-жающими тканями [8,9].…”

The Impact of Extensive Cytoreductive Surgery for Ovarian Cancer on the Histopathology Laboratory Workload

“…A number of studies have consistently shown that optimal cytoreduction is associated with a significant survival benefit in patients with this disease [8,11,14].…”

“…Studies have shown that residual disease (RD) after initial surgery is a strong independent prognostic factor for survival and recurrence, with improvements in both overall and progression free survival being greatest in women with no (currently termed complete cytoreduction) or minimal (<1 cm, currently termed optimal cytoreduction) visible residual disease post-operatively [4][5][6][12][13][14]. A number of studies have consistently shown that optimal cytoreduction is associated with a significant survival benefit in patients with this disease [8,11,14].…”

Digestive resections in advanced-stage ovarian cancer

“…A majority of women will have advanced-stage disease at initial diagnosis, and this is intimately linked to poor prognosis of the disease. The International Federation of Gynecology and Obstetrics (FIGO) classification of the disease stage is the strongest predicting factor of survival [3] . Patients with advanced-stage disease will experience relapse and only 20%-25% of patients can be expected to be long-term survivors despite showing a good response to primary treatment [4] .…”