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World J Obstet Gynecol. Nov 10, 2013; 2(4): 101-107
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.101
Cytoreductive surgery after recurrent epithelial ovarian cancer and at other timepoints
Paolo Sammartino, Tommaso Cornali, Marialuisa Framarino dei Malatesta, Pompiliu Piso
Paolo Sammartino, Tommaso Cornali, Department of Surgery Pietro Valdoni, Policlinico Umberto I, 00161 Rome, Italy
Marialuisa Framarino dei Malatesta, Department of Gynecological Obstetrical and Urological Sciences, Policlinico Umberto I, 00161 Rome, Italy
Pompiliu Piso, Department of General Surgery, Barmherzige Brüder Hospital, 93049 Regensburg, Germany
Author contributions: Sammartino P, Cornali T, dei Malatesta MF and Piso P designed research, analyzed data and wrote the paper.
Correspondence to: Paolo Sammartino, MD, Department of Surgery Pietro Valdoni, Rome, Policlinico Umberto I, Via del Policlinico, 00161 Rome, Italy. paolo.sammartino@uniroma1.it
Telephone: +39-33-6615632 Fax: +39-64-9972146
Received: December 13, 2012
Revised: March 28, 2013
Accepted: May 8, 2013
Published online: November 10, 2013
Abstract

In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient’s symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defined. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these findings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials (Arbeitsgemeinschaft Gynäkologische Onkologie-Desktop III and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a definitive answer to the matter.

Keywords: Ovarian cancer, Cytoreductive surgery, Recurrent ovarian cancer, Secondary cytoreduction, Surgery for Platinum sensitive ovarian cancer, Surgery for Platinum resistant ovarian cancer

Core tip: The chief surgical problem to face after primary treatment is recurrent ovarian cancer. The role of surgery in recurrent ovarian cancer remains poorly defined. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these findings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed.