Primary debulking surgery of advanced epithelial ovarian cancer in developing countries: challenges and expectations

Ovarian cancer often presents itself in advanced stages and can be accompanied by various comorbidities. Treatment options are primary debulking surgery (PDS) followed by adjuvant chemotherapy, or alternatively, neoadjuvant chemotherapy followed by interval debulking surgery (IDS). The option taken is based on several considerations. If the patient can be treated with PDS, the absence of macroscopic residual disease becomes an independent prognostic factor. However, achieving this outcome is a challenge for the gynaecologic oncologist since advanced stage ovarian cancer generally metastasizes into the peritoneum and the upper abdominal organs. Optimal outcomes are that surgery will be safe for the patient, no macroscopic residual disease is achieved, minimal postoperative complications are encountered, and a good survival rate is obtained. Developed countries, especially Europe, have well-recognized standards of care which are followed by developing countries; however, challenges with insurance coverage and inter-departmental cooperation are recognized hurdles in developing countries. Competency improvement along with good inter-departmental communication and collaboration are keys to optimal outcomes for PDS.