A subset of women with ovarian cancer will present with an apparently isolated adnexal mass. Many of these women will have early stage ovarian cancer with a relatively good prognosis. Unfortunately, the majority of women with ovarian cancer present with advanced disease due to widespread intraperitoneal metastases. The surgical management of advanced ovarian cancer has undergone dramatic transformations over the past 20 years and that will be the focus of this presentation. A large body of retrospective data accumulated which indicated that women undergoing cytoreductive surgery for ovarian cancer did much better if all gross disease was resected (“R0”). Based on this, radical upper abdominal surgery to achieve R0 has been adopted into management. Many patients with advanced ovarian cancer are too ill or too advanced for surgery. Such patients are frequently do receive treatment with chemotherapy. It was recognized that many such patients respond well with subsequent improvement in performance status and operability. Based on this, data accumulated on management with neoadjuvant chemotherapy followed by interval cytoreductive surgery for selected patients. This data led to a series of prospective, randomized trials which demonstrated non-inferiority (when compared to primary cytoreductive surgery), along with a reduction in morbidity. Based on this, clinical practice guidelines (combined SGO/ASCO) were published in 2016 (Wright AA, et al.. Gynecol Oncol 2016; 143: 3-15) for primary management of women with advanced ovarian cancer that included evaluation by gynecologic oncologist, imaging with CT scan, utilization of neoadjuvant chemotherapy for women at high risk for surgery or low likelihood of achieving optimal cytoreduction, and histologic confirmation prior to initiation of neoadjuvant chemotherapy.

Learning objectives:

1. To gain an understanding of the evolution over the past 20 years in the surgical management of primary advanced ovarian cancer.
2. To gain insight into the technical aspects of cytoreductive surgery for advanced ovarian cancer.