Ultraradical cytoreductive procedures for primary and relapsed ovarian cancer
Epithelial ovarian cancer (EOC) is the fourth most common cancer in women and the most fatal gynecological
malignancy. Surgery remains one of the main therapeutic modalities, although controversy exists around the
extent and limitations of cytoreductive procedures, the optimum timing of surgery and the selection of ideal
surgical candidates. These issues make the management of this complex disease challenging, and have resulted in
wide variations in practice nationally and internationally. Limits of cytoreductive techniques have now been
extended into the thoracic cavity, extraabdominal lymph nodes etc, so that the rate of patients who can be
operated tumorfree is nowadays much higher than what it used to be. Opponents of maximal effort cytoreductive
surgery argue that increased surgical morbidity resulting in a negative impact on quality of life as well as
exhaustion of financial and institutional resources are detrimental to patient care. Nevertheless, increasing
evidence suggests that specialization and expertise leads to higher tumor resection rates and hence potentially
improved survival without equivalent increase in complication rates or length of hospitalization.
The limits, timing and value of radical cytoreduction on the short- and long term survival of patients with
advanced disease is currently the focus of many large multicentre prospective phase III clinical trials.
• To gain and understand the intraoperative tumor dissemination patterns of advanced ovarian cancer
• To gain knowledge about cytoreductive procedures applied in ovarian debulking procedures
• To understand the impact of surgery on patients survival and quality of life
• Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced
ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002; 20(5):1248-59.
• du Bois A, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced
epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter
trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the
Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO) Cancer. 2009; 115(6):1234-
• Chi DS, Franklin CC, Levine DA, et al: Improved optimal cytoreduction rates for stages IIIC and IV epithelial
ovarian, fallopian tube, and primary peritoneal cancer: a change in surgical approach. Gynecol Oncol 2004; 94
• Bristow RE, Peiretti M, Gerardi M, et al. Secondary cytoreductive surgery including rectosigmoid colectomy
for recurrent ovarian cancer: operative technique and clinical outcome. Gynecol Oncol. 2009; 114(2):173-7.
0.5 CPD credit
Watch the video and complete the online self-reflection form. Go to "My events" to download your certificate. You must login to watch the video and receive CPD.
Consultant Gynaecologic Oncologist, Imperial College Healthcare NHS Trust
Professor Christina Fotopoulou trained in obstetrics and gynaecology and subspecialised in gynaecological oncology at the Charité University Hospital of Berlin in the surgical and systemic treatment of gynaecological cancer. Since 2013, she is a Consultant Gynecological Oncologist at Imperial College London Hammersmith
Hospital in London.
She has been the Vice Director of the Clinic for Gynecology at the Charité in Berlin, one of the largest reference and accredited centers for gynecological cancer in Europe, as well the Principal Coordinator of the European Competence Center for Ovarian Cancer.
Professor Fotopoulou’s principal area of expertise lies in exenterative procedures for advanced forms of pelvic
malignancies, in the cytoreductive procedures for primary or relapsed ovarian cancer and the investigation of predictive and prognostic biomarkers of surgical and clinical outcome.
She is on the editorial board and reviewer of numerous international gynaecological and oncological journals and is member of various international oncological committees.