ABSTRACT
The concept of cytoreductive surgery for epithelial ovarian cancer has evolved since 1935 when Meigs first suggested that as much tumor as possible should be removed to enhance the effects of postoperative irradiation.1 Forty years after Meigs’ initial proposition, Griffiths published a landmark study that provided the first conclusive evidence of an inverse relationship between residual tumor size and patient survival.2
Perhaps the most convincing data for both the benefits and shortcomings of primary cytoreductive surgery is a detailed analysis of 637 patients with advanced ovarian cancer reported by Hoskins et al. for the Gynecologic Oncology Group (GOG) (protocols 52 and 97).3,4 In evaluating patients with both optimal and suboptimal residual disease status, these investigators demonstrated three distinct groups: microscopic residual disease (no gross residual), visible residual disease ≤ 2 cm, and residual disease of > 2 cm. The salient observations of these studies were that survival is inversely related to the volume of residual disease after primary surgery and that primary cytoreduction failed to have a meaningful effect on survival if the largest residual tumor dimension exceeded 2 cm, regardless of the extent of resection.
