Updates in Surgery

, Volume 65, Issue 4, pp 265–270 | Cite as

The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review

  • Salvatore Giovanni VitaleEmail author
  • Ilaria Marilli
  • Melissa Lodato
  • Alessandro Tropea
  • Antonio Cianci
Review Article


It has already been proven that ovarian cancer is the sixth most common cancer among women, and it is considered the leading cause of death by gynecologic cancer in developed countries. This article is a literature review based on the use of cytoreductive surgery matched with adjuvant chemotherapy in advanced-stage ovarian cancer. According to the statistics, the difficulty of obtaining an early diagnosis results in a delay in the disease treatment and as a consequence, in many cases, ovarian cancer is still diagnosed in the advanced stage of the disease. Primary surgery is performed, in addition to diagnosis and staging, to achieve optimal cytoreduction. The purpose of this article is to review the different surgical approaches in the management of epithelial ovarian cancer, specifically the high-stage disease, with a special concentration on the most recent therapeutic additions to our current knowledge, such as hyperthermic intraperitoneal chemotherapy and new therapeutic drugs. Surgical treatment still plays a pivotal role in the management of advanced-stage ovarian cancer. Complete cytoreduction continues to be, when feasible, the objective to be attempted in the surgical treatment of advanced ovarian cancer. Obviously, the success of the operation depends on numerous factors, including patient selection, the locations of tumors, and surgeon expertise. To offer patients the best possible outcome with the least accompanying morbidity, strong consideration should be given to the referral of such patients to expert care centers for primary surgery, because it may be the best means currently available for improving overall survival.


Cytoreductive surgery Advanced Ovarian cancer 


Conflict of interest



  1. 1.
    Berkenblit A, Cannistra SA (2005) Advances in the management of epithelial ovarian cancer. J Reprod Med 50(6):426–438PubMedGoogle Scholar
  2. 2.
    Hogg R, Friedlander M (2004) Biology of epithelial ovarian cancer: implications for screening women at high genetic risk. J Clin Oncol 22:1315–1327PubMedCrossRefGoogle Scholar
  3. 3.
    Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. CA Cancer J Clin 60:277–300PubMedCrossRefGoogle Scholar
  4. 4.
    Van der Burg ME (2001) Advanced ovarian cancer. Curr Treat Options Oncol 2(2):109–118PubMedCrossRefGoogle Scholar
  5. 5.
    Bhoola S, Hoskins WJ (2006) Diagnosis and management of epithelial ovarian cancer. Obstet Gynecol 107(6):1399–1410PubMedCrossRefGoogle Scholar
  6. 6.
    Crawford SC, Vasey PA, Paul J, Hay A, Davis JA, Kaye SB (2005) Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 trial. J Clin Oncol 23(34):8802–8811PubMedCrossRefGoogle Scholar
  7. 7.
    Chi DS, Eisnhauer EL, Zivanovic O et al (2009) Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol 114:26–31PubMedCrossRefGoogle Scholar
  8. 8.
    Dauplat J, Le Bouedec G, Pomel C, Scherer C (2000) Cytoreductive surgery for advanced stages of ovarian cancer. Semin Surg Oncol 19(1):42–48PubMedCrossRefGoogle Scholar
  9. 9.
    Meigs JV (1934) Tumors of the female pelvic organs. Macmillan, New YorkGoogle Scholar
  10. 10.
    Griffiths CT (1975) Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975(42):101–104Google Scholar
  11. 11.
    Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, MOntz FJ (2002) Survival effect of maximal cytreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259PubMedCrossRefGoogle Scholar
  12. 12.
    Hoskins WJ, McGuire WP, Brady MF et al (1994) 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):974–980CrossRefGoogle Scholar
  13. 13.
    Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R (2011) Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev (8): CD007565Google Scholar
  14. 14.
    Zivanovic O, Sima CS, Iasonos A, Hoskins WJ, Pingle PR, Leitao MM Jr, Sonoda Y, Abu-Rustum NR, Barakat RR, Chi DS (2010) The effect of primary cytoreduction on outcomes of patients with FIGO IIIC ovarian cancer stratified by the initial tumor burden in the upper abdomen cephalad to the greater omentum. Gynecol Oncol 116(3):351–357PubMedCrossRefGoogle Scholar
  15. 15.
    Peiretti M, Bristow RE, Zapardiel I, Gerardi M, Zanagnolo V, Biffi R, Landoni F, Bocciolone L, Aletti GD, Maggioni A (2012) Rectosigmoid resection at the time of primary cytoreduction for advanced ovarian cancer. a multi-center analysis of surgical and oncological outcomes. Gynecol Oncol 126(2):220–223PubMedCrossRefGoogle Scholar
  16. 16.
    Vergote I, Amant F, Kristen G, Ehlen T, Reed NS, Casado A (2011) Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer. Eur J Cancer 47(Suppl 3):s88–s92PubMedCrossRefGoogle Scholar
  17. 17.
    Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, Gourgou S, Rouanet P (2009) Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 35(2):135–143PubMedCrossRefGoogle Scholar
  18. 18.
    Rauh-Hain JA, Rodriguez N, Growdon WB, Goodman AK, Boruta DM 2nd, Horowitz NS, Del Carmen MG, Schorge JO (2012) Primary debulking surgery versus neoadjuvant chemotherapy in stage IV ovarian cancer. Ann Surg Oncol 19(3):959–965PubMedCrossRefGoogle Scholar
  19. 19.
    Zheng Hong, Gao Yu-Nong (2012) Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer. Chin F Cancer Res 24(4):304–309CrossRefGoogle Scholar
  20. 20.
    Chua TC, Robertson G, Liauw W, Farrell R, Yan TD, Morris DL (2009) Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductve surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results. J Cancer Res Clin Oncol 135(12):1637–1645PubMedCrossRefGoogle Scholar
  21. 21.
    Matsumoto A, Higuchi T, Yura S, Mandai M, Kariya M, Takakura K, Fujii S (2006) Role of salvage cytoreductive surgery in the treatment of patients with recurrent ovarian cancer after platinum-based chemotherapy. J Obstet Gynaecol Res 32(6):580–587PubMedCrossRefGoogle Scholar
  22. 22.
    Chi DS, McCaughty K, Diaz JP et al (2006) Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 106:1933–1939PubMedCrossRefGoogle Scholar
  23. 23.
    Ozols RF (2006) Systemic therapy for ovarian cancer: current status and new treatments. Semin Oncol 33(2 Suppl 6):s3–s11PubMedCrossRefGoogle Scholar
  24. 24.
    Perren TJ, Swart AM, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, Carey MS, Beale P, Cervantes A, Kurzeder C, Du Bois A, Sehouli J, Kimming R, Stahle A, Collinson F, Essapen S, Gourley C, Lortholary A, Selle F, Mirza MR, Leminen A, Plante M, Stark D, Qlan W, Parmar MK, Oza AM, ICON7 Investigators (2011) A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 365:2484–2496PubMedCrossRefGoogle Scholar
  25. 25.
    Eltabbakh GH, Mount SL, Beatty B, Simmons-Arnold L, Cooper K, Morgan A (2004) Factors associated with cytoreducibility among women with ovarian carcinoma. Gynecol Oncol 95(2):377–383PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Salvatore Giovanni Vitale
    • 1
    Email author
  • Ilaria Marilli
    • 1
  • Melissa Lodato
    • 1
  • Alessandro Tropea
    • 2
  • Antonio Cianci
    • 1
  1. 1.Department of Obstetrics and Gynecology and Radiological Sciences, Gynecology and Obstetrics UnitUniversity of CataniaCataniaItaly
  2. 2.Department of SurgeryUniversity of CataniaCataniaItaly

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