Surgery in advanced ovarian carcinoma: is there proof to show the benefit?

In advanced ovarian carcinoma one of the major prognostic factors for obtaining a pathologically proven complete response and prolonged disease free survival is the amount of tumour at the start of chemotherapy. Therefore, cytoreductive surgery is generally considered mandatory to maximize the chance for cure. However, it has never been proven that the better prognosis is a function of the procedure itself. The available evidence suggests that not everybody benefits optimally from this approach. For this reason a prospective randomized trial is needed to evaluate its real value. Second-look operations to determine the outcome of first line treatment in patients clinically free of disease, have not proven to be of value in terms of survival. Their use should therefore be restricted to a clinical research setting. The value of a second attempt to achieve optimal cytoreduction in patients with palpable disease after first-line cisplatin based chemotherapy has not yet been fully established. It is important that new surgical approaches should also, like new drugs already are, be tested prospectively in a randomized way before they are accepted in daily practice.