Home Forums Obstetrics & Gynaecology Surgery’s Evolving Role in Ovarian Cancer

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    Would you consider surgery in advanced ovarian cancer?

    Shana Wingo, who specializes in gynecologic oncology at Arizona Oncology, in an interview with CURE says, whether a treatment plan includes cytoreduction upfront or neoadjuvant chemotherapy, patients with advanced disease are likely to benefit from surgical approaches that reduce the volume of the tumor.

    Mainly focusing on advanced stage ovarian cancer that has metastasized she said they would consider upfront cytoreduction to remove bulk of the tumor. They call it debulking surgery. What they do now is a laparoscopy first as an initial assessment to determine if a laparotomy to a much larger incision is appropriate. If patients aren’t felt to be appropriate surgical candidates at the time of laparoscopy for debulking, they stop the procedure, give them chemotherapy, and then do an interval cytoreduction where you’re doing debulking. The chemotherapy often shrinks the size of the tumor, leading to better success with cytoreduction.

    She thinks they now have a solid understanding that the less tumor that is left behind, the better patients do. It is about the amount of time they survive. The surgeries that are done can be very labor intensive involving the uterus, cervix, fallopian tubes and ovaries. It may also involve the colon and pancreas, as well as lymph node removal. The omentum is always involved in the surgery.

    She says as time goes on, you find that the more aggressive you are with surgery, perhaps the better patients do based on survival data. So, some of the high-volume centers are doing resection of liver metastases, the gallbladder and pancreas, and splenectomies. The goal is the same: no residual disease. That is a huge difference. The Gynecologic Oncology Group, over time, used to define optimal as less than 2 cm, then became less than 1 cm, and now the goal for all of us is a complete resection of disease.

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