Ovarian Cancer Surgical Updates

*Ovarian Cancer - Updates in Tumour Biology and Therapeutics*

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**Chapter 6**

**Abstract**

**1. Introduction**

The Role of Ultra-Radical Surgery

in the Management of Advanced

*Felicia Elena Buruiana, Lamiese Ismail, Federico Ferrari*

The ovarian cancer, also known as "silent killer", has remained the most lethal gynaecological malignancy. The single independent risk factor linked with improved survival is maximum cytoreductive effort resulting in no macroscopic residual disease. This could be gained through ultra-radical surgery which demands tackling significant tumour burden in pelvis, lower and upper abdomen which usually constitutes bowel resection, liver mobilisation, ancillary cholecystectomy, extensive peritonectomy, diaphragmatic resection, splenectomy, resection of enlarged pelvic, paraaortic, and rarely cardio-phrenic lymph nodes in order to achieve optimal debulking. The above can be achieved through a holistic approach to patient's care, meticulous patient selection, and full engagement of the family. The decision needs to be carefully balanced after obtaining an informed consent, and an appreciation of the impact of such surgery on the quality of life against the survival benefit. This chapter will describe the complexity and surgical challenges

Ovarian Cancer: State or Art

*and Hooman Soleymani Majd*

in the management of advanced ovarian cancer.

over 40% and has remained quite low [3].

**Keywords:** ovarian cancer, stage III and IV, cytoreductive surgery, ultraradical surgery, residual disease, holistic approach, quality of life

oncological surgeons and is often referred to as the "silent killer".

The most common gynaecological cancer treated in women is uterine cancer, however the number of women who die from ovarian cancer is much higher [1]. Ovarian cancer has remained the most lethal cancer treated by gynaecological

Ovarian cancer is the 7th most common cancer, and 8th most common cause of death from cancer in women in the world [2]. World Ovarian Cancer Coalition 2018 estimated that by 2035, the incidence of ovarian cancer will increase to 371, 000 per year. It is currently around 239, 000 cases annually [2]. The crude incidence is 23 to 30 in 100 000 women and most women present with advanced disease and little prospect of cure; the five-year survival rate for all stages of ovarian cancer is just

The treatment for patients with ovarian cancer is debulking surgery and platinum-

based chemotherapy. The amount of residual disease after surgery is the most important prognostic factor for survival [4–11] and a recent phase III clinical trial [9]
