Ovarian cancer: The initial laparotomy

Introduction Surgical assessment and histologic evaluation are the only means by which a neoplasm can be classified as benign or malignant, primary, or metastatic. When an early primary ovarian cancer is diagnosed, the next goal is determining the extent of disease or stage. Surgical staging is required to define those patients in whom surgery alone may be curative and those who will require adjuvant therapy, and to determine the modality, intensity, and duration of such treatment. Accurate surgical staging also permits assignment of prognosis, allows comparison of cure rates, and defines subsequent surveillance. In the 70 to 75% of patients who present with advanced ovarian cancer, the goal of laparotomy is also to remove as much tumor as possible through a process of surgical "cytoreduction" to maximize response to chemotherapy, and improve survival. We offer epithelial ovarian cancer as a model; the principles of treatment also apply to ovarian germ-cell tumors, stromal tumors, and other primary ovarian cancers.