Ovarian cancer cytoreductive surgery

Over the past 30 years it has become largely established that optimal debulking surgery of metastatic epithelial ovarian cancer has a favorable impact on the survival of patients with advanced staged disease. Optimal surgery followed by platinum-based systemic chemotherapy is the cornerstone in the management of ovarian cancer. However, the majority of patients have advanced disease at time of presentation, hampering an optimal effect of primary cytoreduction. Furthermore, a considerable number of patients present with residual disease after frontline chemotherapy or relapse after complete clinical response. 

For second-line treatment no definite therapy has yet been defined. The combination of secondary cytoreduction plus hyperthermic peritoneal perfusion constitutes a feasible and effective option for this subset of patients. Several phase II trials have been published showing a positive effect of second cytoreductive surgery on survival of patients with recurrent or persistent epithelial ovarian cancer. At this moment the role intraoperative hyperthermic peritoneal perfusion is not clear and has to be determined in a prospective randomized trial. 

Kecmanovic DM, Pavlov MJ, Kovacevic PA et al (2003) Cytoreductive surgery for ovarian cancer. Eur J Surg Oncol... 

Zanon C, Clara R, Chiappino I et al (2004) Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer. World J Surg 28(10) 1040-1045... 

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