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

  • Sigit Purbadi1,*,
  • Kade Yudi Saspriyana2,3

1Gynaecology Oncology Division, Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, 10430 Jakarta, Indonesia

2Fellowship Gyanecology Oncology Trainee, Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, 10430 Jakarta, Indonesia

3Department of Obstetric and Gynecology, Faculty of Medicine, Udayana University, Sanglah General Hospital, 80113 Bali, Indonesia

DOI: 10.31083/j.ejgo.2021.01.2230 Vol.42,Issue 1,February 2021 pp.26-29

Submitted: 25 August 2020 Accepted: 20 October 2020

Published: 15 February 2021

*Corresponding Author(s): Sigit Purbadi E-mail:


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.


Ovarian cancer; Primary debulking surgery; Residual disease; Interdepartmental approach; Competency

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Sigit Purbadi,Kade Yudi Saspriyana. Primary debulking surgery of advanced epithelial ovarian cancer in developing countries: challenges and expectations. European Journal of Gynaecological Oncology. 2021. 42(1);26-29.


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