[Surgery in ovarian carcinoma]

Abstract

Surgery remains one of the important factors in the treatment of the ovarian cancer. Ovarian cancer spreads primarily by exfoliating malignant cells from the tumor surface that in turn implant throughout the peritoneal cavity. On the basis of the patterns of this spread, a stage-specific operation for ovarian cancer is currently being established. In early ovarian cancer, the initial operation allows a complete assessment of the spread of the disease. For stage I ovarian cancer, uni- or bi-lateral salpingo-oophorectomy was performed when a patient showed grade I well-differentiated tumor, no extra capsular proliferation, and intact capsule. For patients with advanced disease, the initial cytoreductive operation with the compulsory resection of involved portions of the bowel reduces tumor bulk and produces increased sensitivity to chemotherapy for the remaining tumor. Survival time increases further in proportion to decrements in tumor size below 2 cm in its maximum diameter. Even within the optimal group of patients, in whom the maximum diameter of residual disease was < or = 1 cm, there was a survival difference between patients with microscopic residual disease and those with any macroscopic disease < or = 1 cm. Among with suboptimal group of patients, in whom the maximum diameter of residual disease is > 1 cm, and who receive the following platinum containing chemotherapy, those who have a small diameter of residual disease (< 2 cm) tend to survive longer than those with larger residual disease. Among those with the larger residual disease, the size of the tumor does not affect the prognosis. Optimal or suboptimal tumor resection is associated with a more complete response to chemotherapy. The principles of cellular kinetics provide good theoretical evidence of the benefit of cytoreductive surgery.