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Individuals with ovarian cancer who have been treated to the point of no visible residual disease have demonstrated better survival outcomes in clinical trials. Warner K. Huh, MD, acknowledges that although there is a risk of morbidity in pursuing this outcome, achieving zero-volume disease is the goal of surgery.
European studies have demonstrated that upfront cytoreductive surgery is associated with a survival advantage compared with cytoreductive surgery after 3 cycles of chemotherapy. It is still unclear how much of the outcome of the cytoreductive procedure is due to the biology of the disease versus the quality of the surgery, comments Michael J. Birrer, MD. Also, the effect of the number of chemotherapy cycles after surgery on outcome has not been formally evaluated, adds Robert A. Burger, MD. One of the commonly cited rationales for upfront cytoreductive surgery is to remove large masses to enhance the delivery of chemotherapy, notes James Tate Thigpen, MD.