Surgical management of peritoneal carcinomatosis in ovarian cancer

Abstract

In 2013, it is estimated that over 22,000 women will be diagnosed with ovarian cancer [1]. Since screening strategies have proven ineffective and symptoms often do not develop until later stages, the majority of patients with ovarian carcinoma will present with advanced (stages III or IV) disease. Peritoneal carcinomatosis is a characteristic hallmark of advanced stage disease, in which metastasis are found throughout the upper abdomen in stage III disease, and diffuse peritoneal disease is accompanied by malignant pleural infiltration or visceral metastases in stage IV disease. Peritoneal carcinomatosis is also often found in patients with disease recurrence. Surgical management of carcinomatosis not only provides patients with symptomatic relief from carcinomatosis-related symptoms, but can also improve oncologic outcomes. This chapter discusses the rationale for complete surgical cytoreduction in patients with a new diagnosis of ovarian carcinoma, as well as in patients with recurrent disease (Box 4.1).