Linda R. Duska, MD, professor of obstetrics and gynecology and gynecologic oncologist at the University of Virginia, discusses primary debulking surgery in ovarian cancer.

Primary debulking surgery has demonstrated improved overall survival for patients. However, the procedure can lead to surgical complications. For example, primary debulking surgery has been associated with an increased rate of surgical morbidity or mortality in some patients, says Duska.

As such, patient-related factors including performance status, serum albumin levels, BMI, and other medical comorbidities may lead a surgeon to discuss neoadjuvant chemotherapy with the patient as a less morbid alternative to surgery, concludes Duska.

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Linda R. Duska, MD, discusses primary debulking surgery in ovarian cancer.

Dr. Duska on Primary Debulking Surgery in Ovarian Cancer

Linda R. Duska, MD, professor of obstetrics and gynecology and gynecologic oncologist at the University of Virginia, explains whether the Fagotti score provides an accurate assessment of whether a patient with newly diagnosed, advanced ovarian cancer can achieve a complete resection in surgery.

The Fagotti score can be useful in determining whether a patient with newly diagnosed, advanced ovarian cancer can undergo optimal debulking surgery in the hands of an experienced surgeon, explains Duska. However, it is not the sole way to assess resectability. A small laparotomy could be performed instead, in addition to performing imaging, a CT scan, a PET scan, or an MRI, says Duska.

Ultimately, resectability should be assessed by a trained gynecologic oncologist. Having a gynecologic oncologist involved in the care of women with advanced disease from the onset of treatment is important, says Duska. However, that is not always possible, especially in community practices where general surgeons or gynecologists are more likely to perform the surgery. When that happens, the patient’s likelihood of receiving an appropriate surgery decreases, concludes Duska.

Dr. Duska on the Utility of the Fagotti Score in Advanced Ovarian Cancer

Linda R. Duska, MD, professor of obstetrics and gynecology, University of Virginia, discusses neoadjuvant chemotherapy versus upfront surgical debulking in patients with advanced ovarian cancer.

Many physicians believe that upfront surgical debulking is the best option for most patients with ovarian cancer; however, research is showing that there are subgroups of patients who benefit from neoadjuvant chemotherapy, explains Duska. Some studies suggest that neoadjuvant chemotherapy is equivalent to primary debulking surgery and may be less morbid, according to Duska.

Two studies examining neoadjuvant chemotherapy versus upfront surgical debulking enrolled women who were older, had bulkier disease, and poorer performance status. Duska says this is a different patient population than typical studies, and these studies have been criticized for low debulking rates. However, these data show that a certain subgroup of patients, such as those with stage IV disease, seem to benefit from neoadjuvant chemotherapy over primary debulking surgery, concludes Duska.

Linda R. Duska, MD, discusses neoadjuvant chemotherapy versus upfront surgical debulking in patients with advanced ovarian cancer.

Linda R. Duska, MD

Articles

Dr. Duska on Primary Debulking Surgery in Ovarian Cancer

Dr. Duska on the Utility of the Fagotti Score in Advanced Ovarian Cancer

Dr. Duska on Neoadjuvant Chemo Vs Upfront Surgery in Ovarian Cancer