New paradigms in the surgical and adjuvant treatment of ovarian cancer

Advanced stage epithelial ovarian cancer is difficult to treat. Despite advances in surgical resection and adjuvant chemotherapy the majority of patients suffer from disease recurrence. In an effort to improve oncologic outcomes, including progression free and overall survival, novel surgical paradigms and chemotherapeutic techniques have emerged over the past decade. An emphasis has been placed on achieving maximal surgical cytoreduction (defined as no visible residual disease) at completion of surgery, in combination with intra-peritoneal (IP) chemotherapy, as well as hyperthermic IP chemotherapy (HIPEC). This review article will discuss the evolution of surgical cytoreduction in the treatment of advanced stage epithelial ovarian cancer, as well as the development of adjuvant treatments that increasingly utilize the biologic advantage provided by microscopic residual disease.