[Surgical initial attitude in epithelial ovarian advanced cancer]

The purpose of this work is to show the value of aggressive excisional surgery in epithelial ovarian advanced cancer (COEA).

Between May 1993-May 1997, there were 103 obs. with ovarian diseases; 28 obs. (27.1%) with COEA and 75 obs. (72.9%) with benign diseases. All the patients had a subtotal hysterectomy with bilateral anexectomy and omentectomy. The operation was extended to other anatomic elements; in the case of 4 obs., we practiced a segmentary resection of left colon, 2 obs. had an anterior resection of the rectum and a partial resection of the pelvic peritoneum, 15 obs. suffered an excision of tumoral masses from the gastro colic omentum and the right parietocolic space and 7 obs. had a resection of pelvic peritoneum and of the right parietocolic space peritoneum. The optimal cytoreduction with a tumoral residuum less than 2 cm was realized for 23 obs. (82.14%) and for 5 obs., the tumoral residuum was greater than 2 cm (17.76%). The medium survival of the patients with a tumoral residuum inferior to 2 cm was 41 months, at 4 years 54% of the observations being alive, compared to only 14 months for the patients with tumoral residuum superior to 2 cm, at 4 years the survival being only of 15%. All the observations have beneficiated of chemotherapy. The disease reappeared for 23 obs. after a variable period of time. It's treatment consisted of: surgery followed by chemotherapy for 18 obs. and chemotherapy of second line alone for 5 obs.

The ovarian epithelial cancers, famous for an intermediary answer to chemotherapy, lead to an aggressive surgical management with partial extra genital organ sacrifices, to offer a chance of life.