ASO Author Reflections: Ultra-Radical Resection in Ovarian Cancer: Where Are We and Where Are We Going?

Excerpt

In recent decades, survival rates and operability have increased due to improvements in surgical and medical therapies. Residual disease after cytoreductive surgery is nowadays considered the most important prognostic factor in patients affected by advanced ovarian cancer, although a non-negligible incidence of surgery-related complications and mortality increases with increasing surgical effort.1‐3 Historically, hepatobiliary involvement has been generally considered a predictive marker of suboptimal resection and, therefore, a contraindication to extensive debulking in the treatment of ovarian cancer. However, what was considered a contraindication in gynecologic oncology represented a feasible and reproducible routine practice for hepatobiliary surgeons. Moreover, recently the surgical paradigm for the treatment of ovarian cancer patients has changed. Surgical efforts to avoid residual tumor have been strongly increasing over recent years due to substantial improvements in perioperative care and surgical skills, aiming to achieve better results in terms of optimal cytoreduction, even with disease spreading in challenging areas, such as liver and porta hepatis.1,2 Preliminary experiences with liver resection, biliary surgery and porta hepatis surgery in advanced ovarian cancer treatment have been reported.4 If, on one hand, standardized indications for these surgical procedures are not yet available, on the other hand, there are no longer strict contraindications for surgical treatment in these scenarios. …