The benefits of ovarian cancer surgery, known as cytoreduction or debulking in advanced cases, have been debated for years. Proponents of very aggressive surgery insist that this is the only way a gynecologic oncologist can reliably improve the chance of cure when faced with advanced ovarian cancer. Others disagree and suggest that it is the "tumor biology" that dictates whether or not cure will be achieved. In other words, is the cancer sensitive to chemo or not from the beginning? So, which side is right?

The problem is that we have no way of knowing before surgery whether or not the cancer will be chemosensitive or not. So, one of the theories behind aggressive surgery is that the surgery itself can increase the chances that the cancer will be chemosensitive. How, or if, this works is still being debated. One can get buried in debating the scientific reasons for this, but the bigger question is, "Does aggressive surgery help?".

Virtually all of the studies that have been published to date show that the closer surgery can get to leaving no visible disease behind, the better the outcome. So, in this regard, more is better assuming that there are no medical reasons which might limit an aggressive and prolonged surgery.

The latest study on the benefits of maximal cytoreduction (nothing visible at the end of surgery) comes from Sloan Kettering in New York. Their main conclusion was that surgery which left no visible disease was associated with the best survival and least chemoresistance. Is it because the surgery actually improved the chemosensitivity? That is still not provable. However, when it is possible in an otherwise healthy patient, it seems that removing all visible cancer does help. Is it always possible? No, not in their research or any of the other published studies. However, it is certainly a goal to always consider.