[Surgical therapy of ovarian carcinoma]

Ovarian carcinomas tend towards swift intraabdominal spreading and to frequent retroperitoneal involvement of the pelvic and paraaortic lymph nodes. At first surgery about 80% of the ovarian carcinomas have already left the small pelvis and are diagnosed as FIGO-stage III or IV. The preoperative diagnostics should register as accurately as possible the intra- and extra-abdominal spreeding. The postoperative residual tumor is of great importance for the prognosis. The aim of the operation being the reduction of the postoperative residual tumor to a diameter of less than 1-2 cm. If this is not successful, a substantial improvement of the prognosis cannot be expected from the first surgery. Exact staging with careful documentation of the postoperative residual tumor forms the essential basis for an optimal cytostatic or radiation therapeutical follow-up treatment. The trend towards radical surgical procedure led in our cases, unexpectedly to no increase in postoperative complications. A more conservative surgical procedure with the aim of preserving fertility in younger women, who wish to have children, requires the secure evidence of stage Ia and proof of a tumor with a low malignancy grade, given by an experienced histologist. It may be possible that other guide-lines are required for some germ cell tumors.