Surgical advances in the treatment of ovarian cancer

Surgical intervention remains a key component in the diagnosis and management of epithelial ovarian carcinomas. Although the parameters defining "optimal" tumor cytoreduction continue to evolve, data validate the concept of complete operative tumor resection to no visible residual disease in all stages of ovarian cancer to prolong disease-free and overall survival. In select patients, recurrent disease also may be managed with surgical cytoreduction. At the other end of the spectrum, prophylactic bilateral salpingo-oophorectomy has been shown conclusively to reduce the risk of ovarian cancer in women at high risk. Although BRCA1-associated and BRCA2-associated gynecologic cancer syndromes do not seem to include uterine malignancies, the role of hysterectomy to remove the fallopian tube completely is controversial. Finally, new data support the concept of conservative, fertility-sparing surgery in a select group of women with early-stage disease. Although laparoscopy may be feasible in staging women with disease apparently limited to an ovary, further studies are necessary before it can be considered routinely as an alternative to standard laparotomy.