N.A. Ognerubov – Dr.Sc.(Med.), Professor, Head Department of Oncology, 

G.R. Derzhavin Tambov State Medical University 

D.N. Kushlinsky – Ph.D. (Med.), Department of Radiation and Combined Methods of Treatment  of Gynecological Diseases, A.F. Tsyb Medical Radiological Scientific Center – Branch of the Federal 

State Budgetary Institution «National Medical Research Center of Radiology»  of the Ministry of Health of Russia (Obninsk)

A.S. Shevchuk – Ph.D. (Med.), Head Oncology Department of Surgical Methods  of Treatment (Oncogynecology) Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center for Oncology» of the Ministry of Health of Russia (Moscow)

Statement of the problem. The main method of treating ovarian cancer is surgical, the main task of which is to remove the maximum possible volume of the tumor and metastases. Despite the desire for complete cytoreduction, the authors use various approaches and classifications of the radicality of the surgical method in patients with ovarian cancer.

Aim of the work – analysis of current trends in the surgical treatment of early and common stages of epithelial ovarian cancer. The work presents a systematic review of literature data on various aspects of surgical treatment of epithelial ovarian cancer, while the authors used an accessible electronic domestic database and the PubMed / Medline database for January 2020.

Results. The authors emphasize the important role of surgical staging in epithelial ovarian cancer. With this intervention, a series of surgical procedures are performed through laparotomy to determine the true prevalence of the process. In this case, the authors pay special attention to certain methods of a controversial nature. So, with an omentectomy, the border of the large omentum should pass along the greater curvature of the stomach, which ensures the completeness of its removal and revision of the omental bursa. Performing retroperitoneal lymphadenectomy depends on the stage and variant of the histological structure. In the early stages, its appropriateness is disputed. Since the frequency of metastatic lesions of the lymph nodes is 1.2-22%, and with mucous tumors, most authors do not recommend including it in surgical treatment. In the common (III-IV) stages, indications for retroperitoneal lymphadenectomy are the possibility of complete or optimal cytoreduction or a suspicion of their metastatic lesion. The appropriateness of an appendectomy is still under discussion. So, according to the authors, the frequency of metastatic lesion of the appendix is 13.9%. In their opinion, appendectomy should be included as a routine intervention in surgical + staging, regardless of the process. Performing it in the early stages allows you to increase the stage, and with a common process – to increase the optimality of cytoreduction. The main task of cytoreductive intervention in ovarian cancer is to remove the maximum possible volume of the tumor and metastases. In this regard, during surgical treatment, it is necessary to strive for complete or optimal cytoreduction. The authors give various classifications of the radicalness of cytoreduction. In recent years, a new direction in the treatment of advanced ovarian cancer has appeared – the implementation of interval cytoreduction after neoadjuvant chemotherapy. The purpose of this option is to increase the frequency of complete cytoreduction. However, the results of a series of meta-analyzes did not reveal the advantages of such tactics in terms of overall and disease-free survival. Recently, minimally invasive technologies have firmly taken a leading position in gynecological oncology. However, the available literature on the use of this option in the treatment of epithelial ovarian cancer is very controversial. Most studies, including 2020, when performing surgical interventions, especially in the common stages, prefer laparotomy. The probability of radical cytoreduction can be predicted using predictor factors, which include the level of CA-125, HE-4, peritoneal carcinomatosis index and intraoperative mapping of peritoneal lesions.

Practical significance. With epithelial ovarian cancer, regardless of the stage of the process, the main treatment method is surgical. It is based on the principle of complete surgical staging and maximum cytoreduction. In the early stages of the disease, it is performed as an independent option or in combination with adjuvant taxane-containing polychemotherapy, and in the common process after neoadjuvant polychemotherapy (in recent years), which allows increasing the frequency of complete cytoreduction.

Ognerubov N.A., Kushlinsky D.N., Shevchuk A.S. Surgical treatment of ovarian cancer (review). Technologies of living systems. 2020. V. 17. № 2. P. 18–30. DOI: 10.18127/j20700997-202002-02 (In Russian).

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