Surgical management of epithelial ovarian cancer

Epithelial ovarian cancer is the sixth most common cancer in women in the US and still remains the most lethal of gynecologic cancers. Diagnosis at an advanced stage and development of resistance to chemotherapy, despite remarkable initial chemosensitivity, account for the grim overall prognosis in these patients. Surgery still remains the cornerstone for the diagnosis and the management of this disease. In patients with apparently early disease, it is critical to perform thorough surgical staging to define the subset of patients who would benefit from adjuvant chemotherapy. Preservation of the uterus and the uninvolved contralateral adnexa is acceptable in selected patients. In advanced disease, aggressive cytoreductive surgery is associated with improved response to chemotherapy, prolonged disease-free survival, and overall survival. The timing of debulking and the extent of debulking are discussed.