Maximal cytoreductive surgery in advanced ovarian cancer

The standard form of surgical intervention in advanced ovarian cancer is to undertake a pelvic clearance, and remove all tumour. When the latter is not feasible, then a ‘debulking’ operation is performed. This is a procedure whereby the intra-abdominal tumour load is reduced to what is termed ‘optimum’ residual disease (which has varied definitions). Compared with other intra-abdominal solid tumours, this approach is unique to ovarian malignancies. Whilst many retrospective studies, and meta-analyses may indicate that patients with ‘optimum’ debulking survive longer than those with a greater amount of residual disease, the reality is that this surgical intervention has never been exposed to a randomised controlled trial. Therefore, rather than ‘optimum’ debulking enhancing survival, it could be that the ability to achieve the ‘optimum’ is only reflecting the inherent tumour biology of a more chemo-sensitive disease. This debate will continue until such studies are completed.