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Surgical Approaches Continue to Evolve in Ovarian Cancer

Gina Columbus @ginacolumbusonc
Published: Monday, Apr 10, 2017

Shana Wingo, MD

Shana Wingo, MD

For patients with advanced ovarian cancer, surgical resection continues to be an effective and essential tool in the armamentarium, according to Shana Wingo, MD.

State of the Science Summit on Ovarian Cancer. In an interview during the meeting, she explained how surgical approaches have evolved in ovarian cancer.

OncLive: What did you discuss at this meeting in your overview of surgery in ovarian cancer?

Wingo: We covered what we do for ovarian cancer and how we manage patients, mainly focusing on advanced stage ovarian cancer and what we do for patients when they initially present. Generally, what happens is that for the majority of patients, we consider upfront cytoreduction, which is for bulky disease that has metastasized and we remove the bulk of the tumor. We also call it debulking surgery. 

One of the things that is getting traction and is more adopted now is doing laparoscopy as an initial assessment to determine if a laparotomy to a much larger incision is appropriate. If patients aren’t felt to be appropriate surgical candidates at the time of laparoscopy for debulking, then we stop the procedure, give them chemotherapy, and then do an interval cytoreduction where you’re doing debulking after they have had some chemotherapy. That shrinks the size of the tumor, leading to better success with cytoreduction. 

What evolution have we seen with surgery in ovarian cancer, and what can we expect going forward?

We now have a real solid understanding that the less tumor that is left behind, the better patients do. Really, we are talking about the amount of time they survive. The surgeries that we do can be very labor intensive from a general perspective. Most of us are probably doing a lot more pelvic surgery—involving the uterus, cervix, fallopian tubes, and ovaries—but then there are bowel resections that might involve the colon and pancreas, as well as lymph node removal. The omentum is always involved in the surgery, which is the upper abdomen.
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