Retrospective evidence supports the value of optimal cytoreductive surgery in the initial therapy of patients with advanced ovarian cancer. Specialized procedures, including radical pelvic surgery, bowel resection, and diaphragm resections, are frequently necessary to accomplish optimal cytoreduction. Cytoreduction and total gross tumor removal are possible more frequently with new surgical instruments such as the Cavitron ultrasonic surgical aspirator and argon beam laser. Pelvic and periaortic lymph node resection is an important aspect of cytoreductive surgery, and systematic removal of grossly uninvolved lymph nodes may improve survival. Secondary cytoreductive surgery appears to benefit a select group of patients.
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References
1.
BurghardtE., GirardiF., LahouserM.Patterns of pelvic and periaortic lymph node involvement in ovarian cancer. Gynecol Oncol.1991; 40: 103–106.
2.
GriffithsC.T.Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr.1975; 42: 101–104.
3.
HackerN.F., BerekJ.S., LagasseL.D.Primary cytoreductive surgery for epithelial ovarian cancer. Obstet Gynecol.1983; 61: 413–420.
4.
VoglS.E., PaganoM., KaplanB.H.Cisplatin based combination chemotherapy for advanced ovarian cancer: high overall response rate with curative potential only in women with small tumor burdens. Cancer.1983; 51: 2024–2030.
5.
PohlR., Dallenbach-HellwegG., PluggeT.Prognostic parameters in patients with advanced malignant ovarian tumors. Eur J Oncol.1984; 3: 160–169.
6.
DelgadoG., OramD.H., PetrilliE.S.Stage III epithelial ovarian cancer: the role of maximal surgical reduction. Gynecol Oncol.1984; 18: 293–298.
ConteP.F., BruzzoneM., ChiaraS.A randomized trial comparing cisplatin plus cyclophosphamide versus cisplatin, doxorubicin, and cyclophosphamide in advanced ovarian cancer. J Clin Oncol.1986; 4: 965–971.
9.
NeijtJ.P., ten Bokkel HuininkW.W., van der BurgM.E.Randomised trial comparing two combination chemotherapy regimens (Hexa-CAF vs CHAP-5) in advanced ovarian carcinoma. Lancet.1984; 2: 594–600.
10.
PiverM.S., LeleS.B., MarchettiD.L.The impact of aggressive debulking surgery and cisplatin-based chemotherapy on progression-free survival in stage III and IV ovarian carcinoma. J Clin Oncol.1988; 6: 983–989.
HoskinsW.J., BundyB.N., ThigpenJ.T.The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol.1992; 47: 159–166.
13.
Farias-EisnerR., TengF., OliveiraM.The influence of tumor grade, distribution, and extent of carcinomatosis in minimal residual stage III epithelial ovarian cancer after optimal primary cytoreductive surgery. Gynecol Oncol.1994; 55: 108–110.
14.
HoskinsW.J., McGuireW.P., BradyM.F.The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol.1994; 170: 974–980.
15.
EisenkopS.M., SpirtosN.M., MontagT.W.The impact of subspecialty training on the management of advanced ovarian cancer. Gynecol Oncol.1992; 47: 203–209.
BarnesW., JohnsonJ., WaggonerS.Reverse hysterocolposigmoidectomy (RHCS) for resection of panpelvic tumors. Gynecol Oncol.1991; 42: 151–155.
19.
BerekJ.S., HackerN.F., LagasseL.D.Lower urinary tract resection as part of cytoreductive surgery for ovarian cancer. Gynecol Oncol.1982; 13: 87–92.
20.
SoperJ.T., CouchmanG., BerchuckA.The role of partial sigmoid colectomy for debulking epithelial ovarian cancer. Gynecol Oncol.1991; 41: 239–244.
21.
SonnendeckerE.W., GuidozziF., MargoulisK.A.Splenectomy during primary maximal cytoreductive surgery for epithelial ovarian cancer. Gynecol Oncol.1989; 35: 301–306.
22.
MontzF.J., SchlaerthJ.B., BerekJ.S.Resection of diaphragmatic peritoneum and muscle: role in cytoreductive surgery for ovarian cancer. Gynecol Oncol.1989; 35: 338–340.
23.
BurghardtE., PickelH., LahousenM.Pelvic lymphadenectomy in operative treatment of ovarian cancer. Am J Obstet Gynecol.1986; 155: 315–319.
24.
KigawaJ., MinagawaY., IshiharaH.Evaluation of cytoreductive surgery with lymphadenectomy including para-aortic nodes for advanced ovarian cancer. Eur J Surg Oncol.1993; 19: 273–278.
25.
SpirtosN.M., GrossG.M., FreddoJ.L.Cytoreductive surgery in advanced epithelial cancer of the ovary: the impact of aortic and pelvic lymphadenectomy. Obstet Gynecol.1995; 56: 345–352.
26.
AdelsonM.D., BaggishM.S., SeiferD.B.Cytoreduction of ovarian cancer with the Cavitron ultrasonic surgical aspirator. Obstet Gynecol.1988; 72: 140–143.
27.
DeppeG., MalviyaV.K., MaloneJ.M.Jr. Debulking surgery for ovarian cancer with the Cavitron ultrasonic surgical aspirator (CUSA): a preliminary report. Gynecol Oncol.1988; 31: 223–226.
28.
RoseP.G.The cavitational ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer. Am J Obstet Gynecol.1992; 166: 843–846.
29.
BrandE., PearlmanN.Electrosurgical debulking of ovarian cancer: a new technique using the argon beam coagulator. Gynecol Oncol.1990; 39: 115–118.
30.
PatsnerB.Carbon dioxide laser vaporization of diaphragmatic metastases for cytoreduction of ovarian epithelial cancer. Obstet Gynecol.1990; 76: 724–727.
31.
FanningJ., HilgersR.D.Loop electrosurgical excision procedure for intensified cytoreduction of ovarian cancer. Gynecol Oncol.1995; 57: 188–190.
32.
EisenkopS.M., NalickR.H., WangH.J.Peritoneal implant elimination during cytoreductive surgery for ovarian cancer: impact on survival. Gynecol Oncol.1993; 51: 224–229.
33.
BerekJ.S., HackerN.F., LagasseL.D.Survival of patients following secondary cytoreductive surgery in ovarian cancer. Obstet Gynecol.1983; 61: 189–193.
34.
LippmanS.M., AlbertsD.S., SlymenD.J.Second-look laparotomy in epithelial ovarian carcinoma: prognostic factors associated with survival duration. Cancer.1988; 61: 2571–2577.
35.
LuesleyD., LawtonF., BlackledgeG.Failure of second-look laparotomy to influence survival in epithelial ovarian cancer. Lancet.1988; 2: 599–603.
36.
HoskinsW.J., RubinS.C., DulaneyE.Influence of secondary cytoreduction at the time of second-look laparotomy on the survival of patients with epithelial ovarian cancer. Gynecol Oncol.1989; 34: 365–371.
37.
PodratzK.C., SchrayM.F., WieandH.S.Evaluation of treatment and survival after positive second-look laparotomy. Gynecol Oncol.1988; 31: 9–24.
38.
MichelG., ZarcaD., CastaigneD.Secondary cytoreductive surgery in ovarian cancer. Eur J Surg Oncol.1989; 15: 201–204.
39.
JanickeF., HolscherM., KuhnW.Radical surgical procedure improves survival time in patients with recurrent ovarian cancer. Cancer.1992; 70: 2129–2136.
40.
WiltshawE., RajuK.S., DawsonI.The role of cytoreductive surgery in advanced carcinoma of the ovary: an analysis of primary and secondary surgery. Br J Obstet Gynaecol.1985; 92: 522–527.
41.
van der BurgM.E.L., van LentM., BuyseM.The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer: Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med.1995; 332: 629–634.
