Surgery for advanced stages of ovarian carcinoma: Strategy and procedures (La chirurgie des cancers de l'ovaire aux stades avance?s: Techniques et strate?gies)

摘要

Epithelial ovarian carcinoma is still frequently detected at an advanced stage with a poor prognosis. It can be improved if the tumour is chemosensitive to a carboplatin and paclitaxel regimen and if a complete macroscopic surgical debulking can be obtained. As the intra-abdominal tumour spread is very heterogeneous, the complexity of surgical procedures needed to achieve a complete tumour reduction varies. We can distinguish standard, radical, and supraradical procedures, the last two being associated with bowel resection which is performed one out of two time. The probability in acheiving complete cytoreduction depends on the surgeon's experience and on the resecability of the tumour. This can be assessed clinically and with CT scan. Currently best chances could be given to patients by addressing them to an expert surgeon. He will be able to select patients with resectable tumours who must be operated soon, and patients with non resectable tumours who may benefit from primary chemotherapy followed byinterval cytoreductive surgery after 3 to 4 courses of chemotherapy. Springer 2006.