How to improve the optimal cytoreductive surgery in advanced ovarian carcinoma

Advanced ovarian carcinoma is a lethal tumour, and its standard treatment is consists of aggressive primary cytoreductive surgery followed by a chemoadjuvance based on platinum agents. We searched the Cochrane Gynaecological Cancer Group Trials Register of 2010, Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE of 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. One of the goals of its management is to achieve the longest overall survival possible, and the most important survival factor is the residual tumour after cytoreductive surgery, obtaining the best surveillance in the cases where no tumour is left in the abdomen. To improve the cytoreductive rates in the actual management strategy, a change is necessary, selecting the cases not suitable for primary debulking surgery and adding, if necessary, procedures different than the ovarian tumour resection, like bowel resections, peritonectomies (particularly diaphragmatic ones) and splenectomies. This review pretends to understand why advanced ovarian carcinoma should be treated with primary surgery whenever possible and to rationate the use of extrapelvic surgical procedures. The improvement of surgical rates with these manoeuvres can determine the best management of our patients, without clinical complications.