Controversial aspects of cytoreductive surgery in epithelial ovarian cancer

No prospective study has been done to elucidate definitely the value of cytoreductive surgery. However, all retrospective studies demonstrate that the size of residual disease prior to initiation of chemotherapy is the single most important determinant of prognosis. In experienced hands, optimal cytoreduction (residual nodules less than or equal to 1.5 cm) is feasible in about 85% of patients, and serious morbidity is acceptably low. Although patients with large metastatic disease usually have phenotypically resistant cells present, even in the small residual nodules, optimal cytoreduction followed by combination chemotherapy which includes cis-platinum can prolong survival by about 12 months and can improve the quality of life. Interval cytoreduction (following chemotherapy) is significantly less beneficial than primary cytoreduction.