Surgical debulking of ovarian cancer: what difference does it make?

Abstract

Three-quarters of women who are newly diagnosed with invasive epithelial ovarian cancer present with stage III to IV disease. Recent data on the efficacy of neoadjuvant chemotherapy have served to challenge the conventional dogma that the preferred initial treatment is surgical debulking. Most of these patients will achieve remission regardless of initial treatment, but 80% to 90% of patients will ultimately relapse. The timing and clinical benefit of a second debulking operation is even more contentious. This article focuses on the recent debate of when or if patients with ovarian cancer should undergo aggressive surgical resection of bulky disease.

Keywords: Interval debulking surgery; Neoadjuvant chemotherapy; Ovarian cancer; Primary debulking surgery; Secondary debulking surgery.

Figure 1

Omental caking.

Figure 2

Survival effect of maximal cytoreductive surgery. Reprinted from Gynecologic Oncology, Vol. 114, Chi DS et al, “Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm,” pp. 26–31, Copyright 2009, with permission from Elsevier.

Figure 3

Overall survival of secondary debulking by amount of residual disease. CL, confidence limits; NA, not applicable. Reprinted from International Journal of Gynecology and Obstetrics, Vol. 108, Schorge JO et al, “Secondary cytoreproductive surgery for recurrent platinum-sensitive ovarian cancer,” pp. 123–127, Copyright 2010, with permission from Elsevier.