[Current trends in the surgical management of ovarian cancer]

Ovarian cancer is the leading cause of death from gynaecological malignancies in western countries, it is diagnosed at an advanced stage in approximately 75% of patients. The current standard treatment for ovarian cancer consists of maximum cytoreductive surgery to reduce tumor residuum to a minimum, followed by platin-based chemotherapy. If an unsuspected ovarian cancer is detected at diagnostic laparoscopy, staging and debulking by laparotomy should be undertaken without delay. For apparently early stages (I or II), appropriate surgical staging is extremely important and will result in the upstaging of about one-third of patients (usually to Stage III). Several retrospective clinical trials show that successful cytoreduction and systemic lymphonodectomy result in an improved survival, but prospective randomized studies have not been performed to evaluate this benefit. Patients who cannot initially be cytoreduced to an optimal stage should be considered candidates for interval cytoreduction after chemotherapy. Repeated surgical debulking in relapsed patients will probably only benefit a small subset of selected patients (e.g. disease-free interval > 2 years). Surgery may also be important for palliation, such as for the treatment of bowel obstruction to improve the patients quality of life. The question still remains whether the observed improved survival rates for patients with ovarian cancer are an effect of primary cytoreductive surgery or tumor biology.