Dr Kahn on Recognizing Surgical Limitations in Advanced Ovarian Cancer During Ovarian Cancer Awareness Month

“Unfortunately, right now, we aren’t the best at picking up disease on the small bowel on…CT scans or PET scans…and the technology isn't there to identify these 2-mm miliary spreads of ovarian cancer on the small bowel.”

Ryan Matthew Kahn, MD, MHS, FACOG, a gynecologic oncologist at Baptist Health Miami Cancer Institute, discussed the clinical implications of surgical limitations for the treatment of patients with advanced ovarian cancer in the context of Ovarian Cancer Awareness Month, which is observed annually in September. Lower third needs to be updated with correct name spelling

Achieving complete gross resection at the time of cytoreductive surgery remains the strongest predictor of patient outcomes, he noted. However, accurate triage is critical in determining whether complete gross resection is feasible or whether patients would benefit more from neoadjuvant chemotherapy followed by interval surgery and adjuvant treatment, he explained.

According to Kahn, small bowel involvement represents the greatest challenge to achieving complete gross resection. Ovarian cancer often presents as miliary disease across the small bowel, with hundreds of mm-sized lesions that are not resectable without compromising patient viability, he said. For these patients, neoadjuvant chemotherapy can reduce tumor burden and improve the potential for effective cytoreduction at a later stage, he added. Identifying such patients preoperatively is essential to optimizing outcomes, but current imaging modalities—including CT and PET—lack the sensitivity to reliably detect small bowel deposits, he reported. This gap underscores an urgent need for more advanced imaging tools or biomarkers to guide surgical decision-making, he highlighted.

Kahn emphasized that closing these diagnostic and surgical gaps will be critical to improving long-term outcomes in ovarian cancer. Although advances like minimally invasive surgical techniques and enhanced recovery protocols have significantly reduced morbidity and improved recovery after surgery, progress in identifying patients who are unlikely to achieve complete gross resection remains limited, he contextualized.