Optimal primary surgical treatment for advanced epithelial ovarian cancer

Abstract

During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable, the surgical goal should be optimal (< 1 cm) residual disease. Due to the high risk of bias in the current evidence, randomised controlled trials should be performed to determine whether it is the surgical intervention or patient-related and disease-related factors that are associated with the improved survival in these groups of women. The findings of this review that women with residual disease < 1 cm still do better than women with residual disease > 1 cm should prompt the surgical community to retain this category and consider re-defining it as 'near optimal' cytoreduction, reserving the term 'suboptimal' cytoreduction to cases where the residual disease is > 1 cm (optimal/near optimal/suboptimal instead of complete/optimal/suboptimal).

Advanced Ovarian Cancer: Primary or Interval Debulking? Five Categories of Patients in View of the Results of Randomized Trials and Tumor Biology: Primary Debulking Surgery and Interval Debulking Surgery for Advanced Ovarian Cancer

“…This was confirmed in a Cochrane analysis [14] in which complete cytoreduction during PDS for AOC was recommended. The authors of the Cochrane analysis also proposed new definitions to describe tumor state after debulking as follows: optimal, near-optimal, and suboptimal for those left with 0 cm, #1 cm, and .1 cm RD, respectively [14].…”

“…After screening the abstracts, assessing the full-text articles, and identifying additional records through the reference lists of selected articles, we included 5 RCTs [5][6][7][8][9], 3 meta-analyses, and 3 Cochrane reviews [10][11][12][13][14][15][16] in this review. Three RCTs compared NACT-IDS with chemotherapy only [5][6][7].…”

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

“…The amount of residual tumor after PDS is an important prognostic factor for survival in several retrospective and prospective studies (1,11). Thus, great efforts including radical surgical procedures have been made to achieve optimal cytoreduction.…”

Neoadjuvant, adjuvant and long-term intravenous/intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy for ovarian cancer

“…Analysis revealed no difference in survival for any of the combinations. [33][34][35][36] At many institutions, patients do not receive IP/IV chemotherapy after NACT+ICS, and at present data is limited, except of two studies: i) a phase II Southwest Oncology Group Study, that studied the use of IP/IV chemotherapy after NACT+ICS in stage III/IV ovarian cancer patients, of whom optimal cytoreduction was thought to be unlikely on imaging. Only 26 patients of the 58 received NACT, ICS and postoperative IP/IV chemotherapy.…”