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Intraoperative staging in ovarian cancer.

In patients with early Stage I or II ovarian cancer a meticulous staging laparotomy is required; this should include omentectomy, pelvic and paraaortic lymphadenectomy, multiple peritoneal biopsies and diaphragmatic biopsies. Adjunctive therapy is based on these surgical-pathological findings. In patients with advanced disease (Stages III and IV) it has been demonstrated that optimal tumour reduction enhances the length of survival. A complete resection of all gross disease in the abdominal cavity is the goal. If this goal can be achieved, a pelvic and para-aortic lymph node dissection should be included. Postoperative adjunctive therapy should be based on the surgical pathologic findings. The planning of adjunctive therapy starts in the operating room, appropriate tissue specimens should be submitted for special studies, such as for receptor status. Intravenous and intraperitoneal access catheters should be placed during surgery for appropriate postoperative treatment. In spite of all the advances in the surgical management and adjunctive treatment for ovarian cancer, improvement in long-term survival is still missing. Each patient poses a different set of circumstances. Each patient needs individualized care, and surgical staging is the first and may be the most important step towards the development of an optimal comprehensive treatment plan.