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World J Obstet Gynecol. Nov 10, 2013; 2(4): 116-123
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.116
Cytoreductive surgery in primary advanced epithelial ovarian cancer
Luca Ansaloni, Federico Coccolini, Fausto Catena, Luigi Frigerio, Robert E Bristow
Luca Ansaloni, Federico Coccolini, Department of General and Emergency Surgery, Ospedali Riuniti, 24128 Bergamo, Italy
Fausto Catena, Department of General and Emergency Surgery, Ospedale di Parma, 43121 Parma, Italy
Luigi Frigerio, Department of Obstetrics and Gynecology, Ospedali Riuniti, 24128 Bergamo, Italy
Robert E Bristow, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, CA 92868, United States
Author contributions: Ansaloni L, Coccolini F and Bristow RE contributed to study conception, literature analysis, manuscript writing and editing; Catena F and Frigerio L contributed to literature search and analysis.
Correspondence to: Luca Ansaloni, MD, Department of General and Emergency Surgery, Ospedali Riuniti, Largo Barozzi 1, 24128 Bergamo, Italy. lansaloni@ospedaliriuniti.bergamo.it
Telephone: +39-35-2699712 Fax: +39-35-266567
Received: December 13, 2012
Revised: February 2, 2013
Accepted: March 6, 2013
Published online: November 10, 2013
Processing time: 339 Days and 8.8 Hours
Abstract

Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients (about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy (CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease (RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefit of surgery. It’s still undefined how the intrinsic features of the tumor make intra-abdominal implants easier to remove. Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the definition of RD is not universal. A unique and definitive definition is needed.

Keywords: Ovarian cancer; Cytoreduction; Complete; Hyperthermic intraperitoneal chemotherapy

Core tip: The present paper reviews the efficacy of complete cytoreductive surgery in the treatment of primary advanced epithelial ovarian cancer. Outlining the importance for standard criteria in defining the completeness of cytoreduction. Moreover the biology of the tumor plays an important role in survival benefit of surgery. It’s

still undefined how the intrinsic features of the tumor make intra-abdominal implants easier to remove. Adjuvant and hyperthermic intraperitoneal chemotherapy could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology.