Role of cytoreductive surgical treatment in the management of advanced ovarian cancer.

Twenty-eight abdominal operations were performed on 26 consecutive patients with stage III and IV ovarian carcinoma over a 3-year period. The goal of each operation was to excise all tumors greater than 1 cm in diameter. This goal was achieved in 12 of 15 primary operations, in seven of nine operations after induction chemotherapy, and in three of four operations performed for tumor recurrence. There were two major complications but no postoperative deaths. Analysis of survival and disease status indicated that patients having operations followed by chemotherapy fared the best. Analysis of prognostic variables suggested that the administration of combination chemotherapy was the most important determinant of survival once the surgical goal had been accomplished. In this latter group, all nine patients who were evaluable by laparoscopy had responded to adriamycin-cyclophosphamide and eight of the nine had complete responses.