Complete Cytoreduction in Advanced Epithelial Ovarian Cancer: The Time Has Come to Define a Standard Boundary

Abstract

Objective:

The aim of this review was to standardize the components of complete cytoreduction for advanced ovarian cancers across centers so that occult sites harboring disease are found.

Methods:

This review is based on literature and clinical experience gained over decades in a tertiary cancer-care institute. All relevant literature was searched in PubMed, SCOPUS, Medline,^® and Google Scholar to find the optimal resection for complete cytoreductive surgery (CRS). The authors' experience was added to discover the boundaries of optimal cytoreduction.

Results:

The most definitive way to eradicate occult disease is to have uniformity across surgeons to assess—and thereby resect—disease in these regions. An important strategy is to remove entire parietal peritoneum rather than only resecting the disease-bearing peritoneum. Another essential strategy is to resect the falciform and round ligament of the liver, irrespective of visible disease. It is vital to investigate the lesser omentum, omental bursa, surface of the pancreas, caudate lobe of the liver, and the celiac and portal lymph nodes as parts of comprehensive staging. Evidence also suggests that pelvic and para-aortic lymph-node dissection (LND) improve survival and should be included routinely in cytoreductive procedures. Uniformity across surgeons to integrate these occult areas of metastasis for resection for advanced-stage ovarian cancer surgeries may facilitate complete cytoreduction.

Conclusions:

Resecting the total parietal peritoneum, pelvic and para-aortic lymph-nodes, greater and lesser omentum, truly achieves optimal CRS. (JGYNECOL SURG 40:23)