Ovarian cancer: surgery as the cornerstone of treatment

In the field of gynecologic oncology, ovarian cancer remains one of the most challenging diseases, but also one in which research and surgical advances are making some of the most significant progress. Dr. Alessandro Buda, head of gynecologic oncology and obstetrics at the “Michele and Pietro Ferrero” Hospital in Verduno (Cuneo), explains how surgery continues to be the foundation of treatment and how precision medicine and targeted therapies are reshaping patient outcomes.

The Central Role of Surgery

«Surgery, first and foremost, remains a fundamental pillar in the treatment of ovarian cancer, especially in advanced stages – explains Buda –The goal is to completely remove all visible disease, as this has major prognostic value: it reduces the risk of recurrence and extends patient survival».

The therapeutic approach requires close integration between surgery and chemotherapy. Surgery can be performed immediately—via primary cytoreduction—or after neoadjuvant chemotherapy when the patient’s condition or the extent of the disease does not support immediate intervention.

International guidelines, supported by recent multicenter and prospective studies, indicate that overall survival improves significantly when surgery is performed in highly specialized centers with dedicated expertise and multidisciplinary teams capable of ensuring complete removal of macroscopic disease.

When to operate and when to wait

«Whenever possible, we aim to perform surgery upfront – Buda notes – Surgery after chemotherapy can be more complex, as treatment induces fibrotic, scarring, and inflammatory changes that make intervention more challenging».

In cases where surgical risk is high or the disease cannot be safely removed—as shown through diagnostic tests or exploratory laparoscopy—neoadjuvant chemotherapy followed by delayed surgery is recommended.
This standardized approach allows clinicians to identify which patients will benefit most from such a complex procedure.

Surgical innovations: less invasive, better quality of life

In recent years, gynecologic oncology surgery has made tremendous strides in precision and reduced invasiveness. «Being able to operate without opening the abdomen—using robotic or minimally invasive techniques, is a great advantage – says Dr. Buda – Especially for patients with early-stage tumors, laparoscopy allows for faster recovery and fewer complications, while maintaining the same oncologic outcomes».

Robotic surgery and traditional laparoscopy now make it possible to perform complex staging procedures even in anatomically difficult areas such as the retroperitoneum, with oncologic results comparable to open surgery.
In younger patients with early-stage disease, fertility-sparing procedures (preserving the uterus or healthy ovaries) represent an important achievement, maintaining oncologic safety while protecting the possibility of future pregnancy.

Collaboration and continuous training are essential. For this reason, on December 4–5 an international webinar titled Breaking News in Gynecologic Oncology: Combining Surgical Know-how and Artificial Intelligence will take place, led by Dr. Buda. The faculty includes leading experts from around the world and will focus on integrating advanced surgical skills with artificial intelligence tools for gynecologic cancer management.

Targeted therapies and immunotherapy: a pharmacological revolution

While surgery remains at the heart of treatment, the other major breakthrough comes from targeted therapies. «The use of PARP inhibitors and, more recently, immunotherapy has changed the natural history of the disease – says Buda – Survival benefits are clear, especially for patients with BRCA1 and BRCA2 gene mutations or homologous recombination deficiency».

PARP inhibitors, introduced in Italy in 2018, work by blocking DNA repair mechanisms in tumor cells, making them more vulnerable to treatment. Recent scientific evidence confirms that these therapies, used as maintenance after chemotherapy, can extend progression-free survival by more than two years in patients with sensitive genetic mutations.

Immunotherapy, in combination with standard treatments, marks another major step forward thanks to its ability to “reactivate” the immune system against cancer cells.

Toward precision medicine

«Today we can no longer avoid personalizing treatments – Buda emphasizes – Each patient must be assessed based on her genetic and molecular profile to identify the most effective therapies».

Therapeutic personalization is based on genetic and biomolecular tests that identify key tumor alterations, making it possible to select surgical and pharmacological treatments with the best benefit-risk ratio.
This approach, Buda explains, «optimizes the benefits of standard treatments, reduces toxicity, and improves quality of life».

Patients with advanced ovarian cancer—once associated with poor prognosis—can now live longer and better. Thanks to the combination of high-complexity surgery, innovative drugs, and a multidisciplinary approach, the disease is increasingly managed as a chronic condition, with survival prospects that would have been unthinkable just a few years ago.