Surgery

Patients must undergo full surgical staging—generally early ovarian cancer of good prognosis (Stage Ia-b, well differentiated) does not require adjuvant chemotherapy. A surgical staging procedure consists of:

♦ A midline incision

♦ Total abdominal hysterectomy

♦ Bilateral salpingo-oophorectomy

♦ Omentectomy

♦ Multiple peritoneal biopsies and washings

♦ Lymph node sampling of the para-aortic and pelvic regions

♦ Careful assessment of the subdiaphragmatic areas

There is uncertainty as to which patients with Stage I disease require adjuvant chemotherapy and there are three trials (MRC, EORTC, and Scandinavian) currently addressing this issue.

Radical surgery plays an important role in the treatment of ovarian cancer. In addition, a randomized trial has shown that for patients who cannot be optimally debulked at initial laparotomy, interval debulking surgery after three cycles of chemotherapy confers a significant survival benefit. It is reasonable to treat with chemotherapy and plan interval debulking surgery if clinical and imaging assessment show that optimal debulking will not be possible. A small proportion of patients of child-bearing age who wish to preserve fertility may be treated by conservative surgery, but these patients need careful selection and counselling.

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