Predicting the Outcome of Cytoreductive Surgery for Advanced Ovarian Cancer A Review

Introduction: Ovarian cancer is the leading cause of gynecologic cancer-related mortality in the United States. Surgical cytoreduction is the cornerstone of current treatment in patients with advanced disease, but it offers the best chances for overall survival when optimal cytoreduction is achieved. Clinicopathological and radiological models for predicting optimal resectability have not been universally applicable. Objective: To summarize the existing surgical data on current serologic, radiological, and surgical tools used to predict the resectability of advanced ovarian cancer. Methods: Systematic review of surgical studies on primary cytoreductive surgery for advanced ovarian cancer reported in the English-language literature between 1980 and 2009. Results: Seventeen retrospective studies using cancer antigen 125, and 8 retrospective studies using radiological imaging modalities to predict resectability of advanced ovarian cancer were reviewed. Five laparoscopic-based reports of ovarian cancer resectability were also reviewed as well as 5 studies examining the role of clinicopathological variables affecting surgical cytoreductive ability. These studies were analyzed according to the rate of optimal cytoreduction achieved and the reported sensitivity, specificity, accuracy, and predictive values of predictive parameters described. Finally, the various conclusions were compared. Conclusions: The rates of optimal cytoreduction vary among surgeons. A universally applicable clinical model that can predict which patients will undergo optimal cytoreduction remains elusive. More research is needed to devise a set of uniform criteria that can be used to predict ovarian cancer resectability among different patient populations.