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An update on preoperative assessment of the resectability of advanced ovarian cancer

  • Philippe Kadhel EMAIL logo , Aurélie Revaux , Marie Carbonnel , Iptissem Naoura , Jennifer Asmar and Jean Marc Ayoubi
Published/Copyright: August 9, 2019
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Hormone Molecular Biology and Clinical Investigation
From the journal Hormone Molecular Biology and Clinical Investigation Volume 41 Issue 3

Abstract

The best prognosis for advanced ovarian cancer is provided by no residual disease after primary cytoreductive surgery. It is thus important to be able to predict resectability that will result in complete cytoreduction, while avoiding unnecessary surgery that may leave residual disease. No single procedure appears to be sufficiently accurate and reliable to predict resectability. The process should include a preoperative workup based on clinical examination, biomarkers, especially tumor markers, and imaging, for which computed tomography, as well as sonography, magnetic resonance imaging and positron-emission tomography, can be used. This workup should provide sufficient information to determine whether complete cytoreduction is possible or if not, to propose neoadjuvant chemotherapy which is preferable in this case. For the remaining patients, laparoscopy is broadly recommended as an ultimate triage step. However, its modalities are still debated, and several scores have been proposed for standardization and improving accuracy. The risk of false negatives requires a final assessment of resectability as the first stage of cytoreductive surgery by laparotomy. Composite models, consisting of several criteria of workup and, sometimes, laparoscopy have been proposed to improve the accuracy of the predictive process. Regardless of the modality, the process appears to be accurate and reliable for predicting residual disease but less so for predicting complete cytoreduction and thus avoiding unnecessary surgery and an inappropriate treatment strategy. Overall, the proposed procedures are heterogeneous, sometimes unvalidated, or do not consider advances in surgery. Future techniques and/or models are still needed to improve the prediction of complete resectability.

Keywords: cancer staging; complete cytoreduction; ovarian cancer; predictive model

Author statement

  1. Research funding: Authors state no funding involved.

  2. Conflict of interest: Authors state no conflict of interest.

  3. Informed consent: Not applicable.

  4. Ethical approval: Not applicable.

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Received: 2019-06-08
Accepted: 2019-07-12
Published Online: 2019-08-09

© 2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Special Section: "Update in the management of ovarian cancer"; Guest Editors: René Druckmann and Adolf E. Schindler
  2. Editorial
  3. Preface to special issue: update in the management of ovarian cancer
  4. Original Article
  5. Ovarian cancer screening in the general population
  6. Review Articles
  7. Non-surgical prevention strategies in women with hereditary breast and ovarian cancer syndromes
  8. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: an update
  9. Genetic testing in ovarian cancer – clinical impact and current practices
  10. The place of secondary complete cytoreductive surgery in advanced ovarian cancer
  11. An update on preoperative assessment of the resectability of advanced ovarian cancer
  12. Impact of retroperitoneal lymph node dissection in ovarian cancer – time for paradigm shift?
  13. Minireviews
  14. Ultrasound screening of ovarian cancer
  15. How to manage BRCA mutation carriers?
  16. Regular Issue
  17. Original Articles
  18. Progestogen addition with low-dose levonorgestrel intrauterine system in menopausal hormone treatment gives less normal breast tissue proliferation than oral norethisterone acetate or medroxyprogesterone acetate
  19. The effectiveness of military physical exercise on irisin concentrations and oxidative stress among male healthy volunteers
  20. Periodontal status and bone metabolism in women in reproductive and postmenopausal periods
  21. Modulatory effect of tropisetron in the liver of streptozotocin-induced diabetes in rats: biochemical and histological evidence
  22. Celecoxib versus mefenamic acid in the treatment of primary dysmenorrhea
  23. The predictive role of amylase and lipase levels on pancreas injury diagnosis in patients with blunt abdominal trauma
  24. Case Report
  25. Low hormone levels during an attack of systemic capillary leak syndrome normalizing after treatment
https://doi.org/10.1515/hmbci-2019-0032
Keywords for this article
cancer staging; complete cytoreduction; ovarian cancer; predictive model

Articles in the same Issue

  1. Special Section: "Update in the management of ovarian cancer"; Guest Editors: René Druckmann and Adolf E. Schindler
  2. Editorial
  3. Preface to special issue: update in the management of ovarian cancer
  4. Original Article
  5. Ovarian cancer screening in the general population
  6. Review Articles
  7. Non-surgical prevention strategies in women with hereditary breast and ovarian cancer syndromes
  8. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: an update
  9. Genetic testing in ovarian cancer – clinical impact and current practices
  10. The place of secondary complete cytoreductive surgery in advanced ovarian cancer
  11. An update on preoperative assessment of the resectability of advanced ovarian cancer
  12. Impact of retroperitoneal lymph node dissection in ovarian cancer – time for paradigm shift?
  13. Minireviews
  14. Ultrasound screening of ovarian cancer
  15. How to manage BRCA mutation carriers?
  16. Regular Issue
  17. Original Articles
  18. Progestogen addition with low-dose levonorgestrel intrauterine system in menopausal hormone treatment gives less normal breast tissue proliferation than oral norethisterone acetate or medroxyprogesterone acetate
  19. The effectiveness of military physical exercise on irisin concentrations and oxidative stress among male healthy volunteers
  20. Periodontal status and bone metabolism in women in reproductive and postmenopausal periods
  21. Modulatory effect of tropisetron in the liver of streptozotocin-induced diabetes in rats: biochemical and histological evidence
  22. Celecoxib versus mefenamic acid in the treatment of primary dysmenorrhea
  23. The predictive role of amylase and lipase levels on pancreas injury diagnosis in patients with blunt abdominal trauma
  24. Case Report
  25. Low hormone levels during an attack of systemic capillary leak syndrome normalizing after treatment
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