The Role of Cytoreductive/Debulking Surgery in Ovarian Cancer

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  • 1 From the Department of Gynecologic Oncology, Division of Surgery, City of Hope, Duarte, California.
  • 2 Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Ovarian cancer is the fifth most common cause of cancer-related death among women in the United States, although the median survival of patients has been increasing over the past few decades. In patients with epithelial ovarian cancer, chemotherapy has increased survival. Platinum agents combined with taxanes have become standard treatment. Intraperitoneal chemotherapy has also increased survival. Cytoreductive surgery to optimally debulk a tumor or, ideally, remove any gross disease has also been shown to increase survival. Each 10% increase in cytoreduction correlates with a 5.5% increase in median survival. The ability to successfully perform optimal cytoreduction ranges from 20% to 90%. Many institutions have recently begun to perform aggressive/ultraradical procedures to achieve this result. Interval cytoreduction may also benefit patients whose initial surgery is suboptimal, especially if the first procedure was performed by a surgeon unfamiliar with the disease. Secondary cytoreduction can increase survival in patients with low-volume disease and a long disease-free interval. All of these procedures should be performed by a specialist trained in ovarian cancer surgery.

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Correspondence: Mark T. Wakabayashi, MD, MPH, Department of Gynecologic Oncology, Division of Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA 91010-3000. E-mail: mwakabayashi@coh.orgDisclosure: Kerrin G. Robinson, MA, has disclosed no relevant financial relationships.
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