Initial Surgery for Ovarian Cancer at Specialized Centers May Improve Survival
According to a recent article published in Gynecologic Oncology, patients with ovarian cancer who undergo initial surgery at a medical center with expertise in surgery for their disease appear to achieve a significant survival benefit.
Approximately 25,000 new cases of ovarian cancer are diagnosed in the U.S. each year. Standard treatment for ovarian cancer involves the surgical removal of as much cancer as possible (if the patient is eligible for surgery), as well as chemotherapy and/or radiation therapy.
If ovarian cancer is detected and treated prior to spread from its site of origin, chances of a cure are promising. However, the vast majority of patients with ovarian cancer are diagnosed with advanced cancer, or cancer that has already spread from the ovary. Cure rates for women with advanced ovarian cancer remain dismal.
Surgery is an integral component of treatment for all stages of ovarian cancer. Surgeons attempt to remove all of the cancer and sometimes perform a second surgery following chemotherapy and/or radiation to remove any remaining cancer.
Results from previous studies have demonstrated that patients treated by surgeons, physicians, and other healthcare providers who perform high volumes of surgeries or care for high volumes of patients with very specific diseases tend to have improved outcomes. Unfortunately, patients who live in very rural areas may have a difficult time accessing specialized treatment centers.
Researchers from Denmark recently conducted a clinical trial to evaluate possible differences in outcomes of patients with ovarian cancer who undergo initial surgery in a specialized, central medical center. The trial included 107 patients in the County of North Jutland who were treated with initial surgery from 1999 to 2002 at the Gynecologic Oncology Center. These 107 patients represented 95.5% of all women diagnosed with ovarian cancer in that county.
Patients had been diagnosed with stages I (cancer not spread from ovary) to IV (cancer spread to distant sites in the body); all had initial surgery at the Gynecologic Oncology Center. Optimal debulking (no cancer remaining that is bigger than 2 cm in diameter) was achieved in at least 78% of patients. Patients then underwent standard chemotherapy. Results were as follows:
- Post-operative death (death within 30 days of surgery) occurred in only 3.7% of women.
- For all patients, median survival was nearly 4 years.
- Patients with stages IIIC and IV disease (the most advanced stages) had a median survival of 32 months.
- For patients with optimally debulked stages IIIC and IV disease (79.5%), median survival was 41 months.
- Overall median survival was improved by 15 months for all stages of ovarian cancer when compared to regional and national data.
The researchers concluded that specialized treatment centers that perform initial surgery for all stages of ovarian cancer appear to provide significantly improved survival for these patients. This trial included the centralization of a primary center for a specific county in Belgium; however, because the U.S. is much larger, bringing this concept into clinical practice may prove more difficult. Nonetheless, this study supports similar finding of previous studies: Specialized surgeons tend to provide improved outcomes for their patients.
Patients diagnosed with ovarian cancer may wish to find a specialized center for initial surgery for their disease.
Reference: Andersen E, Knudsen A, Svarrer T, et al. The results of treatment of epithelial ovarian cancer after centralisation of primary surgery. Results from North Jutland, Denmark. *Gynecologic Oncology.*2005;99: 552-556.
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