Surgical considerations in ovarian cancer.

A primary consideration for effective management of ovarian cancer is distinguishing patients with advanced bulky disease from those with other stages of disease. It is important to determine whether a tumor is confined to one ovary or is more wide-spread. Surgical management includes removal of both ovaries and tubes, the uterus, omentum, and bulk of the disease. The degree of bulk reduction achieved significantly impacts on survival. Conservation is justified in some cases. Intraperitoneal treatment with platinum-based chemotherapy postsurgery appears to substantially benefit patients with minimal residual disease. In a study comparing two catheter methods, fewer complications were noted with the disposable single-use catheter than with the implanted catheter. Surgical endstaging can definitively identify cured patients. However, it is a difficult procedure and is contraindicated in patients with severe intercurrent illness, previous extensive radiotherapy, and an obliterated peritoneal cavity.