Featuring Dr. Pedro Ramirez, MD
Chair, Department of OB-GYN | Houston Methodist Neal Cancer Center
In this episode of Connect Over Coffee, Dr. Pedro Ramirez, one of the world’s leading gynecologic oncologic surgeons, shares evidence-based insights on ovarian cancer surgery, evolving treatment strategies, and how patients can be empowered to make informed, collaborative decisions about their care.
Patient-Centered Surgical Decision-Making
Dr. Ramirez emphasizes a critical principle:
“A good surgeon knows how to operate. A great surgeon knows when not to operate.”
Surgery First vs. Chemotherapy First
Five major randomized clinical trials—including the landmark TRUST trial—demonstrate no difference in overall survival between:
- Primary debulking surgery followed by chemotherapy, and
- Neoadjuvant chemotherapy followed by interval surgery
However, chemotherapy first is consistently associated with fewer complications and safer outcomes. As a result, 80–85% of patients today receive chemotherapy first, a major shift from earlier practice.
Patients should ask:
- What is the likelihood all visible disease can be removed?
- What evidence supports this treatment sequence?
Surgical Advances & De-escalation
The field is moving toward less aggressive, more precise surgery, including:
- Increased use of minimally invasive surgery during interval debulking
- Investigation of fluorescence-guided surgery to detect residual disease (still experimental)
- Growing exploration of whether some patients may not need surgery at all if modern therapies fully control disease
Recovery & Quality of Life
Enhanced Recovery After Surgery (ERAS) protocols are now standard at leading centers. These include:
- Early eating and walking
- Limited IV fluids and opioids
- Aggressive blood clot prevention
ERAS reduces recovery time from weeks to days, improving quality of life without compromising safety
HIPEC: Use With Caution
Heated Intraperitoneal Chemotherapy (HIPEC) is not standard of care in the U.S. It may benefit a narrow group of patients undergoing interval surgery but carries higher complication risks and should only be considered at highly experienced centers
Fertility Preservation
For young patients:
- Advanced ovarian cancer typically precludes fertility preservation
- Early-stage or non-epithelial tumors may allow preservation of the uterus and one ovary
- Pregnancy is generally advised 1–2 years after treatment, once recurrence risk is better understood
Looking Ahead: 2026 and Beyond
Dr. Ramirez is optimistic about the future of ovarian cancer care that will likely witness:
- Molecular profiling as standard of care
- Antibody-drug conjugates and targeted therapies
- Higher response rates (30–40%) and durable disease control
- Expansion of clinical trials (30+ trials anticipated at Houston Methodist in 2026)
Ovarian cancer is increasingly being managed as a chronic disease, allowing patients to live fuller lives while on treatment.
Dr. Ramirez’s final Message to Ovarcomers
Be informed. Ask questions. Seek second opinions when needed. Choose care teams that treat you, not just the disease. Above all, there is real hope, driven by science, collaboration, and patient empowerment.
