Prognosis and Therapy of Ovarian Cancer, Part 1: Patient selection and surgical management in advanced ovarian cancer: what tools do we have to make the right decision?

Background: Ovarian cancer is the gynecological cancer with the worst overall survival worldwide. Around 70% of patients are diagnosed in an advanced stage. Since low residual tumor after surgery has been repeatedly observed to deeply affect survival, the achievement of a complete resection of tumor with no macroscopic residual disease through primary debulking surgery (PDS) has become the standard of care in advanced ovarian cancer. Summary: The concept of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) was introduced to improve resectability in patients who otherwise, due to advanced age, bad performance status or extensive tumor, cannot be optimally operated. Patient related factors like age, performance status, comorbidities and nutritional status can all affect the survival and are all key factors in the selection process. Assessing tumor extension and therefore allocating a patient to the NACT/IDS strategy is of great importance and can be done either through imaging (CT scan, ultrasound, MRI, PET scan) or laparoscopy using different validated laparoscopic scoring systems. Key messages: There is sizable randomized evidence to support the NACT/IDS as an acceptable strategy in patients with advanced ovarian cancer, in whom a PDS is not possible or would have a suboptimal outcome. Patient and tumor related factors play a key role in allocating the right management plan to the right patient.