J Korean Med Assoc.  2016 Mar;59(3):167-174. 10.5124/jkma.2016.59.3.167.

Surgical management of ovarian cancer

Affiliations
  • 1Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea. drchang@ajou.ac.kr

Abstract

Ovarian cancer is the most lethal of the gynecologic cancers worldwide because most patients present with advanced stage disease at the time of diagnosis. Although multiple therapeutic modalities are employed in the management of ovarian cancer, and despite advances in chemotherapeutic and biologic agents, primary surgery followed by adjuvant chemotherapy remains the cornerstone treatment of this disease. Adequate, comprehensive surgical staging in women with early stage ovarian cancer has been shown to improve oncologic outcomes. Complete surgical cytoreduction leaving no gross residual disease is known to be the only physician-driven prognostic factor for patients with advanced disease. This review describes the rationale and surgical steps for full surgical staging for women with early ovarian cancer, and outlines the cytoreductive surgical procedures required to achieve optimal cytoreduction in patients with advanced ovarian cancer. In addition, the impact of radical surgery (as part of maximal tumor debulking) on the amount of residual tumor and on survival rates will be discussed.

Keyword

Ovarian neoplasms; Surgery; Neoplasm staging; Cytoreduction

MeSH Terms

Biological Factors
Chemotherapy, Adjuvant
Diagnosis
Female
Humans
Neoplasm Staging
Neoplasm, Residual
Ovarian Neoplasms*
Survival Rate
Biological Factors

Cited by  2 articles

Recent advances in ovarian cancer treatment
Seung Cheol Kim
J Korean Med Assoc. 2016;59(3):164-166.    doi: 10.5124/jkma.2016.59.3.164.

Experience of Chemotherapy in Ovarian Cancer Patients
Nayeon Shin, Jiyoung Kim
Asian Oncol Nurs. 2017;17(3):158-169.    doi: 10.5388/aon.2017.17.3.158.


Reference

1. Trimbos B, Timmers Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61:69–90.
Article
2. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, Lee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat. 2015; 47:127–141.
Article
3. Kim WY, Choi JS, Park CS, Kim BG, Lee JH, Bae DS. An analysis of clinicopathologic prognostic factors affecting survival in patients with epithelial ovarian cancer. Korean J Obstet Gynecol. 2002; 45:1800–1807.
4. Park HM, Kim YS, Shin EK, Kim MK, Jung KA, Park MH, Chun SH, Ahn JJ, Kim CI, Kim SC. The ability of preoperative serum CA-125 level to predict the outcome of primary cytoreductive surgery of epithelial ovarian carcinoma. Korean J Gynecol Oncol Colposc. 2003; 14:158–166.
Article
5. Kim SC. Consolidation and maintenance therapy for patients with advanced epithelial ovarian cancer. Korean J Obstet Gynecol. 2005; 48:2261–2284.
6. No JH, Park YS, Kim SM, Chung HH, Kim JW, Park NH, Song YS, Kang SB, Lee HP. Pattern of care: epithelial ovarian cancer in case of incomplete previous surgery. Korean J Gynecol Oncol. 2007; 18:195–200.
Article
7. Le T, Adolph A, Krepart GV, Lotocki R, Heywood MS. The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma. Gynecol Oncol. 2002; 85:351–355.
Article
8. Yun JH, Lee HY, Park HW, Shin JW, Lee JM, Park CY. The analysis of prognostic factors in patients with epithelial ovarian cancer. Korean J Obstet Gynecol. 2006; 49:566–571.
9. Shih KK, Chi DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol. 2010; 21:75–80.
Article
10. Chang SJ, Bristow RE. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining ‘optimal’ residual disease. Gynecol Oncol. 2012; 125:483–492.
Article
11. Chang SJ, Bristow RE, Chi DS, Cliby WA. Role of aggressive surgical cytoreduction in advanced ovarian cancer. J Gynecol Oncol. 2015; 26:336–342.
Article
12. Tan DS, Agarwal R, Kaye SB. Mechanisms of transcoelomic metastasis in ovarian cancer. Lancet Oncol. 2006; 7:925–934.
Article
13. Prat J; FIGO Committee on Gynecologic Oncology. FIGO’s staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication. J Gynecol Oncol. 2015; 26:87–89.
Article
14. Jelovac D, Armstrong DK. Recent progress in the diagnosis and treatment of ovarian cancer. CA Cancer J Clin. 2011; 61:183–203.
Article
15. Othersen HB Jr. Ephraim McDowell: the qualities of a good surgeon. Ann Surg. 2004; 239:648–650.
16. Tait L. The pathology and treatment of disease of the ovaries. New York: William Wood & Co;1883.
17. Pemberton FA. Carcinoma of the ovary. Am J Obstet Gynecol. 1940; 40:751–763.
Article
18. Munnell EW. The changing prognosis and treatment in cancer of the ovary: a report of 235 patients with primary ovarian carcinoma 1952-1961. Am J Obstet Gynecol. 1968; 100:790–805.
19. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975; 42:101–104.
20. Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, Ball H, Berek JS. 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; 170:974–979.
Article
21. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a metaanalysis. J Clin Oncol. 2002; 20:1248–1259.
Article
22. Young RC, Decker DG, Wharton JT, Piver MS, Sindelar WF, Edwards BK, Smith JP. Staging laparotomy in early ovarian cancer. JAMA. 1983; 250:3072–3076.
Article
23. Grabowski JP, Harter P, Buhrmann C, Lorenz D, Hils R, Kommoss S, Traut A, du Bois A. Re-operation outcome in patients referred to a gynecologic oncology center with presumed ovarian cancer FIGO I-IIIA after sub-standard initial surgery. Surg Oncol. 2012; 21:31–35.
Article
24. Chang SJ, Bristow RE, Ryu HS. Analysis of para-aortic lymphadenectomy up to the level of the renal vessels in apparent earlystage ovarian cancer. J Gynecol Oncol. 2013; 24:29–36.
Article
25. Stuart GC, Kitchener H, Bacon M, duBois A, Friedlander M, Ledermann J, Marth C, Thigpen T, Trimble E. participants of 4th Ovarian Cancer Consensus Conference (OCCC); Gyne- cologic Cancer Intergroup. 2010 Gynecologic Cancer InterGroup (GCIG) consensus statement on clinical trials in ovarian cancer: report from the Fourth Ovarian Cancer Consensus Conference. Int J Gynecol Cancer. 2011; 21:750–755.
Article
26. Kim HS, Ahn JH, Chung HH, Kim JW, Park NH, Song YS, Lee HP, Kim YB. Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: a meta-analysis. Eur J Surg Oncol. 2013; 39:279289.
Article
27. Zuna RE, Behrens A. Peritoneal washing cytology in gynecologic cancers: long-term follow-up of 355 patients. J Natl Cancer Inst. 1996; 88:980–987.
Article
28. Powless CA, Bakkum-Gamez JN, Aletti GD, Cliby WA. Random peritoneal biopsies have limited value in staging of appa- rent early stage epithelial ovarian cancer after thorough exploration. Gynecol Oncol. 2009; 115:86–89.
Article
29. Lee JY, Kim HS, Chung HH, Kim JW, Park NH, Song YS. The role of omentectomy and random peritoneal biopsies as part of comprehensive surgical staging in apparent early-stage epithelial ovarian cancer. Ann Surg Oncol. 2014; 21:2762–2766.
Article
30. Skipper HE. Adjuvant chemotherapy. Cancer. 1978; 41:936–940.
Article
31. Goldie JH, Coldman AJ. A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep. 1979; 63:1727–1733.
32. Curt GA, Clendeninn NJ, Chabner BA. Drug resistance in cancer. Cancer Treat Rep. 1984; 68:87–99.
33. Skipper HE. Thoughts on cancer chemotherapy and combination modality therapy (1974). JAMA. 1974; 230:1033–1035.
Article
34. Gunduz N, Fisher B, Saffer EA. Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res. 1979; 39:3861–3865.
35. Hacker NF. Controversial aspects of cytoreductive surgery in epithelial ovarian cancer. Baillieres Clin Obstet Gynaecol. 1989; 3:49–57.
Article
36. Omura GA, Bundy BN, Berek JS, Curry S, Delgado G, Mortel R. Randomized trial of cyclophosphamide plus cisplatin with or without doxorubicin in ovarian carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 1989; 7:457–465.
Article
37. Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998; 69:103–108.
Article
38. Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR, Sonoda Y, Levine DA, Hensley M, Barakat RR. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol. 2006; 103:559–564.
Article
39. Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope CR, Wilson TO, Podratz KC, Cliby WA. Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol. 2006; 107:77–85.
Article
40. Winter WE 3rd, Maxwell GL, Tian C, Carlson JW, Ozols RF, Rose PG, Markman M, Armstrong DK, Muggia F, McGuire WP; Gynecologic Oncology Group Study. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007; 25:3621–3627.
Article
41. du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe dʼInvestigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009; 115:1234–1244.
Article
42. Chang SJ, Bristow RE, Ryu HS. Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer. Ann Surg Oncol. 2012; 19:4059–4067.
Article
43. Chang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for ad- vanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol. 2013; 130:493–498.
Article
44. Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R. Optimal primary surgical treatment for advanced epithe- lial ovarian cancer. Cochrane Database Syst Rev. 2011; (8):CD007565.
45. Crawford SC, Vasey PA, Paul J, Hay A, Davis JA, Kaye SB. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial. J Clin Oncol. 2005; 23:8802–8811.
Article
46. Horowitz NS, Miller A, Rungruang B, Richard SD, Rodriguez N, Bookman MA, Hamilton CA, Krivak TC, Maxwell GL. Does aggressive surgery improve outcomes? Interaction between preoperative disease burden and complex surgery in patients with advanced-stage ovarian cancer: an analysis of GOG 182. J Clin Oncol. 2015; 33:937–943.
Article
47. Winter WE 3rd, Maxwell GL, Tian C, Sundborg MJ, Rose GS, Rose PG, Rubin SC, Muggia F, McGuire WP; Gynecologic Oncology Group. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2008; 26:83–89.
Article
48. Wimberger P, Wehling M, Lehmann N, Kimmig R, Schmalfeldt B, Burges A, Harter P, Pfisterer J, du Bois A. Influence of residual tumor on outcome in ovarian cancer patients with FIGO stage IV disease: an exploratory analysis of the AGOOVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group). Ann Surg Oncol. 2010; 17:1642–1648.
Article
49. Wimberger P, Lehmann N, Kimmig R, Burges A, Meier W, Du Bois A; Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group. Prognostic factors for complete debulking in advanced ovarian cancer and its impact on survival: an exploratory analysis of a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol. 2007; 106:69–74.
Article
50. Bristow RE, Chang J, Ziogas A, Campos B, Chavez LR. AntonCulver H. Impact of National Cancer Institute Comprehensive Cancer Centers on ovarian cancer treatment and survival. J Am Coll Surg. 2015; 220:940–950.
Article
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