Advanced cytoreductive surgery: Asia Pacific perspective

The thoroughness of cytoreductive surgery is the largest contributor to survival for patients with advanced ovarian and primary peritoneal carcinoma. For many years the surgery undertaken by Gynaecologic Oncologists has been tailored to match their surgical training. Future surgical training of Gynaecologic Oncologists needs to be tailored to the surgery required to provide complete tumour removal to no residual disease. This means the better teaching of anatomy and an increased scope of surgery to include the general and upper abdominal procedures and management required. This paradigm shift will be a challenge for all and impossible for some. It will require a significant mind-shift not only from our craft group and the profession at large but especially from the speciality Colleges who will need to take these changes on board for future curriculum development. The development of Advanced Cytoreductive Surgical Units needs to be undertaken in a team environment. This requires a commitment from participants at all levels, from the lead oncology surgeon through the hospital administration to the support services involved. While advanced cytoreductive surgery is feasible, it is only in this team environment, limited to major multidisciplinary hospitals, that it can be safely achieved by meticulous attention to detail at all levels.