Surgical treatment of early stage ovarian cancer

abstract

 Highlights

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Early stage (I-IIA) epithelial ovarian cancer can only be properly defined by a thorough and comprehensive surgical staging.

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The completeness of surgical staging is an independent prognostic factor for survival and disease free survival in early stage ovarian carcinoma.

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The effectiveness of adjuvant chemotherapy in properly staged early stage ovarian carcinoma is questionable.

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The treatment of early stage (stage I-IIA) ovarian carcinoma is predominantly surgical and the surgical staging is the most relevant step in the treatment of this disease. The significance of surgical staging is twofold. First, proper staging distinguishes between ‘real’ early stage ovarian carcinoma and ‘perhaps’ early stage disease. The latter carries an appreciable likelihood of unappreciated residual disease in between 16 and 42% of cases. Second, there is solid proof that proper surgical staging is an independent prognostic factor for improved disease-free and overall survival in early stage ovarian carcinoma. The relevance of various staging steps are discussed and surgical guidelines are given in this chapter.

The indication for adjuvant chemotherapy after surgery is closely related to the adequacy of surgical staging. Adjuvant chemotherapy only works in patients in whom surgical staging was inadequate and who, thus, remain with a certain risk of unnoticed residual intraperitoneal or retroperitoneal tumour spread. On the other hand, there is no indication that adjuvant chemotherapy is of any value after an adequate, comprehensive staging procedure. Controversies and misunderstandings on this important issue are discussed.