Cirugía del cáncer epitelial de ovario

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Abstract

Surgery is an essential component, along with chemotherapy, in the treatment of epithelial ovarian cancer (CEO). Its main goal is maximal cytoreduction or complete resection of the tumor (R0) since the presence of residual disease casts a shadow on the prognosis. There are several surgical approaches depending on the stage of the disease: primary debulking, interval debulking after neoadjuvant chemotherapy, secondary debulking for recurrences and conservative surgery in early stages to preserve fertility. The choice of the type of surgery depends on the extent of the tumor and the patient’s condition. Preoperative evaluation and multidisciplinary management are key to optimize the results, highlighting the importance of performing the treatment in specialized centers. In addition, the introduction of new technologies and drugs continues to open promising perspectives in the management of CEO. In early stages primary cytoreduction is of choice. Laparotomy remains the standard, although minimally invasive techniques such as laparoscopy and robotic surgery are gaining acceptance due to their lower morbidity. In advanced stages, surgery should be approached with curative intent to achieve removal of all visible tumor. Recent trials suggest that neoadjuvant chemotherapy followed by interval surgery could be equated to primary cytoreduction in order to reduce morbidity, without compromising survival. However, this technique is the technique of choice when a preoperative evaluation does not allow complete cytoreduction, either because of the extent of the tumor or the patient’s condition.