[Surgical therapy of ovarian carcinoma]

Aim of primary surgery in early stage ovarian cancer (FIGO I-IIA) is a complete removal of all visible tumors and an exact staging of intraabdominal and retroperitoneal tumor spread. Debulking of tumor as radical as possible is the aim of surgery in advanced stages of disease (FIGO IIb-IV). After 2 to 3 cycles of an active polychemotherapy interventional debulking surgery is performed with the intention to remove all existing tumors in those patients with postoperative residual tumor masses > 1 cm in diameter after first surgery. Second-look surgery is performed after 6 cycles of first line polychemotherapy either to confirm a clinical complete remission pathohistologically or to debulk persisting residual tumors. Secondary tumordebulking and its influence on survival as well as the diagnostic value of second-look surgery is discussed controversially, so today second-look is confined to clinical protocols. Cytoreduction of relapsing tumor masses seems to prolong survival in those patients with a relapse free interval of more than 12 months. This seems to be an attractive therapeutic alternative. For the future one can expect more selective operation strategies on the basis of new biologic prognosticators and new developments in minimal invasive operation techniques.