Dr. Fowler on Considerations for Cytoreductive Surgery in Ovarian Cancer

Jeffrey M. Fowler, MD, professor of gynecologic oncology, The Ohio State University, discusses factors used to determine whether a patient with advanced ovarian cancer is eligible for primary cytoreductive surgery.

The first decision surgeons make when patients with advanced ovarian cancer are referred, according to Fowler, is whether to send patients to immediate surgery or neoadjuvant chemotherapy. When making this decision, surgeons must consider performance status, which is the patient’s age plus comorbidities, explains Fowler. Other considerations include anesthesia risk. Combined, these factors help surgeons decide whether to perform surgery and how aggressive to make the surgery.

If a patient is in good health and surgeons think there is a reasonable opportunity for optimal cytoreductive surgery, the patient typically receives surgery. However, if a patient has risk factors that predict higher incidence of adverse events or 30-day mortality, the patient receives neoadjuvant chemotherapy with the goal of interval cytoreductive surgery, Fowler concludes.