Christina Fotopoulou, MD, Imperial College London, London, United Kingdom, discusses the critical challenges in treating advanced ovarian cancer, focusing on identifying optimal surgical candidates and timing for surgery. Administering adjuvant chemotherapy in primarily inoperable patients is crucial, as it can render previously inoperable patients suitable for surgery, especially those with extensive liver or chest metastases. Prof. Fotopoulou emphasizes that neoadjuvant chemotherapy should not be misused to avoid high-quality surgery. The consensus is that patients with stage IV ovarian cancer should undergo surgery, but determining who would benefit most is key. The discussion also covers the feasibility of one-stage versus two-stage procedures for patients requiring extensive multi-cavity operations, such as liver resections combined with peritoneal cytoreduction. These decisions depend on patient fitness and ability to withstand complex surgeries. Such detailed algorithms have been published and shared with the broader gynecologic community. This interview took place at the ESMO Gynaecological Cancers Congress 2024 in Florence, Italy.
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