Cytoreductive Surgery in Ovarian Cancer
Cytoreductive (debulking) surgery improves survival in advanced epithelial ovarian, fallopian tube, and primary peritoneal cancers [1][2]. Both primary debulking and interval debulking after neoadjuvant chemotherapy are endorsed as standard approaches [2]. Secondary cytoreduction may be considered for isolated first relapse after a treatment‑free interval of ≥6 months [3].
Indications for Primary Debulking
- Stage IIIC–IV disease with resectable disease on imaging or laparoscopy.
- No contraindicating comorbidities that preclude extensive surgery.
- Patient fitness for major abdominal operation (e.g., ASA ≤ III).
Interval Debulking
- Administer 3–4 cycles of platinum‑taxane chemotherapy when optimal primary cytoreduction is unlikely.
- Re‑evaluate for surgery after chemotherapy; aim for no gross residual disease.
Secondary Cytoreduction
- First ovarian cancer relapse confined to the pelvis or abdomen.
- Treatment‑free interval ≥6 months after completion of front‑line chemotherapy.
- Good performance status and feasibility of achieving optimal cytoreduction.
Surgical Goals and Outcomes
- Target of no macroscopic residual disease correlates with longest progression‑free and overall survival.
- Complete cytoreduction (CC‑0) is the preferred outcome; CC‑1 (≤2.5 mm residual) may be acceptable when CC‑0 is unattainable.
- High‑volume centers report higher rates of optimal debulking and lower peri‑operative morbidity.
Peri‑operative Considerations
- Pre‑operative assessment should include renal function evaluation, especially when hyperthermic intraperitoneal chemotherapy (HIPEC) is planned, as AKI risk is elevated after CRS‑HIPEC [4].
- Multidisciplinary planning with anesthesia, intensive care, and oncology teams reduces complications.
Role of HIPEC
- HIPEC may be offered at the time of interval debulking in selected patients with high‑grade serous disease, based on emerging data.
- Patient selection should consider tumor burden, performance status, and renal function to mitigate AKI risk [4][5].
Follow‑up After Cytoreduction
- Routine imaging and CA‑125 monitoring every 3–4 months for the first 2 years, then at increasing intervals.
- Maintenance therapy (e.g., PARP inhibitors) is recommended per molecular profile and guideline updates [6].