Jeffrey M. Fowler, MD, professor of gynecologic oncology, The Ohio State University Comprehensive Cancer Center—–James, discusses patient eligibility for cytoreductive surgery in newly diagnosed ovarian cancer.

The first decision makers that physicians make when a patient is referred with advanced-stage ovarian cancer is the age of the patient and whether the age is a critical variable. Technically, there is no an age limit to be able to undergo surgery, but some physicians only conduct surgery upon patients ≤65 years old of age or patients ≤75 years of age. However, it is age combined with what a patient’s performance status is or is not that can also affect the decision. Anesthesia risk score is another important variable, as well as other findings that may give hints of how aggressive physicians have to perform be with surgery.

If a patient is in good health and there is a reasonable opportunity for optimal cytoreductive surgery, the approach is to take that patient for primary cytoreductive surgery. If they have risk factors that would predict higher incidence adverse events or 30-day mortality, thoseare the patients should start with neoadjuvant chemotherapy with the goal of an interval cytoreductive surgery, concludes Fowler.

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Jeffrey M. Fowler, MD, discusses patient eligibility for cytoreductive surgery in newly diagnosed ovarian cancer.
 

Dr. Fowler on Patient Eligibility for Cytoreductive Surgery in Ovarian Cancer

Jeffrey M. Fowler, MD, professor of gynecologic oncology, The Ohio State University Comprehensive Cancer Center—–James, discusses selection criteria that can help determine which surgical procedure to pursue in ovarian cancer.

Radical tumor debulking procedures such as splenectomy, diaphragm resection, large bowel resection with anastomosis, or dual bowel resections may be considered for fit patients who are likely to achieve no gross residual disease after surgery, says Fowler.

Patients whose tumor is <1 cm should be considered for radical tumor debulking procedures on an individualized basis, explains Fowler.

Notably, a hysterectomy with bilateral salpingo-oophorectomy, peritoneal stripping, or omentectomy with or without lymph node dissection can also be used to resect a patient’s tumor to <1 cm, concludes Fowler.

Jeffrey M. Fowler, MD, discusses selection criteria that can help determine which surgical procedure to pursue in ovarian cancer.

Dr. Fowler on Selection Criteria for Surgical Procedures in Ovarian Cancer

Jeffrey M. Fowler, MD, professor of gynecologic oncology, The Ohio State University, discusses the various types of surgical procedures in ovarian cancer.  

The majority of patients with ovarian cancer will need a hysterectomy with a bilateral salpingectomy, says Fowler. Young women with early stage disease who request a fertility-sparing procedure may undergo surgery to remove the disease without removing the uterus, fallopian tubes, or ovaries.

If there is evidence of extraovarian primary peritoneal carcinoma, a tumor cytoreductive surgery may be performed. Simple cytoreductive procedures can consist of a small bowel resection, lymph node dissection, peritoneal nodule removal, or omentectomy.

More advanced cytoreductive surgeries include diaphragm resection, radical omentectomy, splenectomy, large bowel resection, or liver resection, says Fowler.

It is important to perform these surgeries with a competent team and to utilize best judgement to either proceed with surgery or give chemotherapy prior to operation, concludes Fowler.  

Jeffrey M. Fowler, MD, discusses the various types of surgical procedures in ovarian cancer.

Dr. Fowler on Types of Surgical Procedures in Ovarian Cancer

Jeffrey M. Fowler, MD, professor of gynecologic oncology, The Ohio State University, discusses factors used to determine whether a patient with advanced ovarian cancer is eligible for primary cytoreductive surgery.

The first decision surgeons make when patients with advanced ovarian cancer are referred, according to Fowler, is whether to send patients to immediate surgery or neoadjuvant chemotherapy. When making this decision, surgeons must consider performance status, which is the patient’s age plus comorbidities, explains Fowler. Other considerations include anesthesia risk. Combined, these factors help surgeons decide whether to perform surgery and how aggressive to make the surgery.

If a patient is in good health and surgeons think there is a reasonable opportunity for optimal cytoreductive surgery, the patient typically receives surgery. However, if a patient has risk factors that predict higher incidence of adverse events or 30-day mortality, the patient receives neoadjuvant chemotherapy with the goal of interval cytoreductive surgery, Fowler concludes.

Jeffrey M. Fowler, MD, discusses factors used to determine whether a patient with advanced ovarian cancer is eligible for primary cytoreductive surgery.

Jeffrey M. Fowler, MD

Articles

Dr. Fowler on Patient Eligibility for Cytoreductive Surgery in Ovarian Cancer

Dr. Fowler on Selection Criteria for Surgical Procedures in Ovarian Cancer

Dr. Fowler on Types of Surgical Procedures in Ovarian Cancer

Dr. Fowler on Considerations for Cytoreductive Surgery in Ovarian Cancer