The impact of pleural disease on the management of advanced ovarian cancer.

Malignant pleural effusion is the most common site of stage IV ovarian cancer. A positive cytology is required for a stage IVA diagnosis. Unfortunately, the accuracy rate of pleural cytology remains low. A number of factors have been identified as prognostic for clinical outcomes in patients with epithelial ovarian cancer (EOC), the International Federation of Gynaecology and Obstetrics (FIGO) stage and residual tumor after debulking surgery being the most widely reported. Thereby careful selection of patients is crucially important, yet no preoperative predictor has proven sufficiently reliable to predict surgical outcome. The authors present a review of the literature on stage IV ovarian cancer specifically focusing on prognostic value of FIGO stage, preoperative workup, role of video-assisted thoracic surgery and maximal cytoreductive surgery.