Abstract

Two surgical aspects in the treatment of early-stage ovarian cancer deserve attention: the likelihood of retroperitoneal node involvement and the possibility of conservative surgery in young patients who desire to preserve reproductive function. Although lymph node involvement has been thought to be infrequent in ovarian cancer, recent reports have documented retroperitoneal node metastases in 9.5-25% of patients with early-stage ovarian cancer. A current prospective randomized trial in Italy, comparing systematic para-aortic and pelvic lymphadenectomy with sample biopsies of retroperitoneum in patients with early disease, should reveal whether systematic lymphadenectomy merely adds to knowledge of the natural history of the disease or whether it will influence subsequent therapy and prognosis. Most researchers agree that conservative surgery should be performed in young patients with borderline tumors and stage I, grade 1 ovarian cancer. Our experience over a 10-year period in which 56% of 99 women aged <40 years with stage I ovarian cancer have been treated with conservative surgery, suggests the possibility of some extension of the traditional conservative approach to patients with unfavorable prognostic factors. Regarding the choice of an optimal postsurgical approach, experience to date has been disappointing. Only cisplatin has shown some promise as an adjuvant treatment of early disease. In an Italian study cisplatin treatment was associated with improved disease-free survival but there was no difference in overall survival when compared with both observation and ³²P treatment. These results suggested the design of a currently ongoing multicenter trial testing platinum-based therapy soon after surgery or at time of relapse.