SECONDARY DEBULKING IN OVARIAN CANCER AND BEYOND
FUTURE PERSPECTIVES The value of radicality in surgery in EOC is currently being challenged worldwide as a result of a combination of lack of robust prospective evidence and the feared high surgical morbidity and mortality which derives from poor surgical expertise in a very challenging surgically disease. Even though in various retrospective but also prospective series the reduction of bulk of disease was clearly associated with significantly longer survival, the factor “tumor biology” is still an uncertain factor that influences survival in pathways still not well defined. Future studies should focus in the mapping of tumor heterogeneity within the abdominal cavity and prospectively correlate phenotypic tumor dissemination patterns with surgical outcome, survival and genomic profiles. Under the perspective of not sacrificing total macroscopic tumor reduction in the landscape of poor surgical quality, efforts should be focused on training and specialization, so that surgical morbidity and mortality are minimized. However, especially in relapsed disease a reflective patients´ selection and identification should be undertaken to avoid performing unnecessary procedures to patients who will hardly benefit. The results of the currently ongoing randomized trials will elucidate this area of unmet need while future studies should focus on assessing the interaction of tumor biology and surgical effort.
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