For the majority of ovarian cancer, surgery is the main treatment and the two main goals of surgery are staging and debulking. For a better outcome, cancer has to be staged and debulked properly – or else the patient needs to have more surgeries later. Therefore, ovarian cancer surgery should be done by a trained and experienced surgical oncologist or a gynecologic surgical oncologist.
The extent of surgery for an ovarian cancer depends on the stage of the cancer, its extent and overall health of the patient. Women of childbearing age who are presented with an early stage ovarian cancer, the cancer can be treated without removing ovaries and uterus.
Cytoreductive surgery is a standard treatment for ovarian cancer. The goal of the surgery is to remove as much visible cancer as possible. Based on the stage and extent of ovarian cancer, the cytoreductive surgery may involve removal of affected ovary (unilateral oophorectomy); both the ovaries (bilateral oophorectomy); both ovaries and fallopian tubes (bilateral salpingo-oophorectomy); single ovary and its adjoining fallopian tube (unilateral salpingectomy).
HIPEC [Hyperthermic Intraperitoneal Chemotherapy]
The patients who are suffering from advanced stage ovarian cancer or recurrent ovarian cancer undergo a complete cytoreductive surgery by which the entire visible disease is resected. In other words, optimal cytoreductive surgery is performed. At the end of the surgery, the temperature of the abdomen is raised to 41 to 43 degrees Celsius by insufflation of warm fluid, and the abdominal cavity is then treated with the infusion of chemotherapy agents like cisplatin for over one and a half hour.
There is a recent evidence in the form of multicentric trial to support this treatment modality. This type of cytoreductive surgery – which is combined with HIPEC, increases the life span of the patient, the disease-free interval, and this can be achieved without unduly affecting the overall morbidity and mortality associated with the procedure.
As far as HIPEC is concerned, it is a fact that the procedure is specialized one, as the patients need to be selected carefully to achieve the best result.
HIPEC requires specialized equipment which raises the intra-abdominal chemotherapy temperature from 41 to 43 degrees Celsius, a temperature at which the most optimal effective dose can be achieved without compromising the safety.