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Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma
Published on: January 22, 2022
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Surgery for advanced epithelial ovarian cancer
Neville F Hacker1, Archana Rao2
1Gynaecological Cancer Centre, Royal Hospital for Women, Randwick NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales, Kensington NSW 2031, Australia.
Best Practice & Research. Clinical Obstetrics & Gynaecology
|November 26, 2016
Summary
Cytoreductive surgery is the gold standard for advanced epithelial ovarian cancer. Complete cytoreduction offers prognostic significance, with neoadjuvant chemotherapy potentially reducing morbidity but increasing surgical difficulty.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
Background:
- Cytoreductive surgery for advanced epithelial ovarian cancer (EOC) has been practiced since 1975.
- Pre-operative metastatic disease extent and post-operative complete cytoreduction are significant prognostic factors.
- Multidisciplinary team management at high-volume cancer units is recommended for EOC patients.
Purpose of the Study:
- To review the current status and considerations for cytoreductive surgery in advanced epithelial ovarian cancer.
- To discuss the role of neoadjuvant chemotherapy and interval cytoreductive surgery.
- To highlight factors influencing post-operative morbidity.
Main Methods:
- Review of historical and recent literature on cytoreductive surgery for advanced EOC.
- Discussion of prognostic indicators and surgical outcomes.
- Analysis of neoadjuvant chemotherapy's impact on morbidity and surgical complexity.
Main Results:
- Complete cytoreduction is a critical goal in surgical management of advanced EOC.
- Neoadjuvant chemotherapy can reduce post-operative morbidity but may increase surgical difficulty due to inflammation.
- Post-operative morbidity is influenced by patient age and the extent of surgical procedures, such as bowel resection.
Conclusions:
- Primary cytoreductive surgery remains the gold standard for advanced EOC until pre-operative prediction of platinum resistance is possible.
- Referral to specialized centers and multidisciplinary care are essential for optimal patient outcomes.
- Investigational approaches like thoracoscopy for intrathoracic disease warrant further research.
