Leading expert in peritoneal surface malignancies, Dr. Paul Sugarbaker, MD, explains why the current standard of care for ovarian cancer surgery is inadequate. He advocates for a more radical surgical approach. Dr. Sugarbaker details the principles of complete cytoreduction. He emphasizes the need to remove all visible disease. He also discusses the critical role of patient selection for extensive procedures. The combination of surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is presented as the optimal treatment strategy.
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Optimizing Ovarian Cancer Surgery: Moving Beyond Standard Debulking
Jump To Section
- The Problem with Current Ovarian Cancer Surgical Standard
- Principles of Radical Cytoreductive Surgery for Ovarian Cancer
- Patient Selection for Extensive Ovarian Cancer Surgery
- Integrating HIPEC with Ovarian Cancer Cytoreduction
- The Path to Improving Ovarian Cancer Treatment Outcomes
- Full Transcript
The Problem with Current Ovarian Cancer Surgical Standard
Dr. Paul Sugarbaker, MD, identifies a fundamental flaw in the prevailing approach to ovarian cancer surgery. The standard of care for most surgeons is tumor debulking. This involves the removal of some, but not all, of the cancerous tumor. Surgeons who perform debulking operations rely on systemic chemotherapy to eradicate the remaining cancer cells left behind.
Dr. Sugarbaker is unequivocal in his assessment, calling this concept "bad." He argues that while ovarian cancer chemotherapy is more effective than chemotherapy for gastrointestinal cancers, it is not a substitute for a complete surgical resection. This inadequate surgical standard contributes to poorer long-term outcomes for patients.
Principles of Radical Cytoreductive Surgery for Ovarian Cancer
The superior alternative, according to Dr. Paul Sugarbaker, MD, is a meticulous and complete cytoreduction. This surgical technique involves peritonectomy procedures and necessary visceral resections. The goal is to achieve a state of no visible evidence of disease.
This radical resection of all visible ovarian cancer tumor is the cornerstone of improved treatment. Dr. Paul Sugarbaker, MD, states that these are the same surgical oncology principles successfully applied in treating peritoneal mesothelioma. He believes this comprehensive approach should be the standard for both primary and recurrent ovarian cancer, yet it is not widely adopted in current practice.
Patient Selection for Extensive Ovarian Cancer Surgery
Dr. Paul Sugarbaker, MD, emphasizes that not every patient is an immediate candidate for such an extensive operation. Careful patient selection is paramount to the success of radical cytoreductive surgery. Factors like a patient's age and overall fitness level must be thoroughly evaluated.
Dr. Sugarbaker cautions against performing an 8-hour procedure on an older, less fit patient. The risk of postoperative mortality or a permanently diminished quality of life is too significant. The interview with Dr. Anton Titov, MD, highlights the ethical and clinical necessity of this selectivity to ensure the benefits outweigh the risks.
Integrating HIPEC with Ovarian Cancer Cytoreduction
Dr. Paul Sugarbaker, MD, presents his best recommendation for advanced ovarian cancer treatment. It is the combination of complete cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). This multimodal approach attacks the cancer on two fronts.
The surgery physically removes all macroscopic disease. The HIPEC procedure then delivers heated chemotherapy directly into the abdominal cavity. This targets any microscopic cancer cells that may remain after surgery, potentially significantly improving survival rates.
The Path to Improving Ovarian Cancer Treatment Outcomes
For Dr. Paul Sugarbaker, MD, the first and most significant step toward better results is adopting a new surgical philosophy. Surgeons must move beyond simple debulking and embrace the goal of complete visible disease removal. This requires specialized training in peritonectomy and visceral resection techniques.
Widespread implementation of this strategy, combined with judicious patient selection and HIPEC, represents the future of ovarian cancer care. As Dr. Sugarbaker concludes, this shift is essential to offering patients the best possible chance for long-term survival and a good quality of life.
Full Transcript
Dr. Paul Sugarbaker, MD: Here is what I would say about ovarian cancer surgery at this point in time. Today the concept of ovarian cancer treatment by surgery is tumor debulking. This is the standard of care for most surgeons performing ovarian cancer treatment by surgical operation.
"Debulking" is removal of some but not all tumor. Surgeons just remove some ovarian cancer tumor and expect the systemic chemotherapy to kill the rest of ovarian cancer tumor cells.
It is true that chemotherapy in ovarian cancer is quite effective. Chemotherapy in ovarian cancer is more effective than chemotherapy of gastrointestinal cancer. But the current treatment standard of surgical debulking of ovarian cancer is a bad concept. It is a bad concept.
Ovarian cancer patients should have the same meticulous cytoreduction with peritonectomy and visceral resections until there is no visible evidence of disease. Ovarian cancer patients should have a radical resection of all visible cancer. This is what we would have for peritoneal mesothelioma. That is not happening at this point.
Radical surgical resection of all ovarian cancer tumor is the first and biggest step in the improved treatment of ovarian cancer. The goal is to bring these surgical oncology principles of peritoneal cavity cancer treatment into treatment of all patients with ovarian cancer. Primary ovarian cancer or recurrent ovarian cancer deserve the best surgical treatment.
Dr. Anton Titov, MD: At the moment it is not happening. More patients with ovarian cancer should have better surgical resection of ovarian tumors?
Dr. Paul Sugarbaker, MD: No, no, it is not the current standard of care for ovarian cancer. At this point in time only a small number of ovarian cancer patients have this treatment. It is very meticulous surgery to remove all ovarian cancer tumor spread from peritoneum.
Some ovarian cancer patients are older women. They are not so fit. It is not appropriate to put them through an 8-hour long surgical procedure, cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Of course, you have to be selective in which ovarian cancer patient to take for radical resection of ovarian cancer.
It doesn't pay to do a big ovarian cancer operation on someone and then have them die after surgery. It is not appropriate to do such an extensive surgery—ovarian cancer cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)—that they can never recover a reasonable quality of life. You have to be selective, of course.
Dr. Anton Titov, MD: But the first step in improving the results of ovarian cancer treatment is this: surgeon has to use peritonectomy with visceral resection to remove all visible evidence of ovarian cancer disease.
Dr. Paul Sugarbaker, MD: My best recommendation for the treatment of patients with ovarian cancer at this point in time is this: it is the meticulous and complete cytoreductive surgery combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC).