Prognostic factors for complete debulking in first- and second-line ovarian cancer.

Abstract

OBJECTIVES: Surgery is a mainstay of therapy in ovarian cancer. Are there any actual changes in the definitions and goals of surgery? METHODS: Selective review of the actual literature and results in surgery for primary and recurrent ovarian cancer. RESULTS: Actual data strongly suggest changing the surgical aim from the so-called optimal debulking (residual disease <1 cm) to complete resection. The standard in patients in whom complete resection might be possible remains to be primary surgery followed by chemotherapy. There might be a subgroup of patients with a poor prognosis who will have only limited benefit of primary surgery, and interval debulking is also possible. Predictive models for suboptimal debulking at primary diagnosis are discussed. The surgical aim in recurrent ovarian cancer is defined as complete resection. Actual multicenter studies investigated prospectively predictive models for complete resection. CONCLUSION: Recommendations regarding surgical aim have changed within the recent years. There are still no reliable predictive models for primary surgery of ovarian cancer. The DESKTOP II trial has validated a score of resectability in recurrent ovarian cancer.