title: Surgery for advanced epithelial ovarian cancer.
abstract: Cytoreductive surgery for patients with advanced epithelial ovarian cancer has been practised since the pioneering work of Tom Griffiths in 1975. Further research has demonstrated the prognostic significance of the extent of metastatic disease pre-operatively, and of complete cytoreduction post-operatively. Patients with advanced epithelial ovarian cancer should be referred to high volume cancer units, and managed by multidisciplinary teams. The role of thoracoscopy and resection of intrathoracic disease is presently investigational. In recent years, there has been increasing use of neoadjuvant chemotherapy and interval cytoreductive surgery in patients with poor performance status, which is usually due to large volume ascites and/or large pleural effusions. Neoadjuvant chemotherapy reduces the post-operative morbidity, but if the tumour responds well to the chemotherapy, the inflammatory response makes the surgery more difficult. Post-operative morbidity is generally tolerable, but increases in older patients, and in those having multiple, aggressive surgical procedures, such as bowel resection or diaphragmatic stripping. Primary cytoreductive surgery should be regarded as the gold standard for most patients until a test is developed which would allow the prediction of platinum resistance pre-operatively.
authors.affiliation: Gynaecological 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. Electronic address: n.hacker@unsw.edu.au.
authors.forename: Neville F
authors.initials: NF
authors.lastname: Hacker
authors.affiliation: Gynaecological Cancer Centre, Royal Hospital for Women, Randwick NSW 2031, Australia. Electronic address: Archana.Rao@health.nsw.gov.au.
authors.forename: Archana
authors.initials: A
authors.lastname: Rao
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: advanced epithelial ovarian cancer; cytoreductive surgery; neoadjuvant chemotherapy