The goal of surgery for a patient with ovarian cancer is to achieve zero-volume disease, notes Robert A. Burger, MD. When planning surgery, Burger considers a patient’s risk of morbidity and mortality, and their potential functional status following surgery, aiming to limit the major morbidity rate to 5% and allow patients normal function after surgery. Burger cautions that clinicians need to be careful not to be overly aggressive.

Warner K. Huh, MD, adds that if a procedure is going to delay the initiation of chemotherapy by 2 to 3 months, the long-term benefit of surgery is unclear. Huh’s primary focus is on performing a successful surgery without delaying subsequent chemotherapy. Following surgery, optimally cytoreduced disease is defined as less than 1 centimeter gross disease remaining at the end of surgery. Burger and Huh agree that when evaluating a surgical program in the United States, they would expect that in an adequate program at least 75% of patients would be classified as having optimally cytoreduced disease after surgery.

James Tate Thigpen, MD, comments that this underscores a potential concern regarding the two European trials that compared neoadjuvant chemotherapy with upfront cytoreductive surgery, as several of the countries in the study had rates of optimal cytoreduction as low as 30% to 45%. Huh remarks that this speaks to the generalizability of the results of the European trials to the United States.