More Evidence that Extensive Surgery to Achieve Cytoreduction Improves Survival
According to a recent article published in Gynecologic Oncology, the removal of extensive cancer spread to the upper abdomen to achieve optimal cytoreduction in women with advanced ovarian cancer significantly improves survival.
Approximately 25,000 new cases of ovarian cancer are diagnosed in the U.S. each year. Regardless of the stage (extent of spread) of ovarian cancer, the removal of as much cancer as possible is associated with improved survival. Specifically, women who achieve optimal cytoreduction, which means that they have no residual cancer mass larger than 1 centimeter in diameter following surgery, tend to have better survival than those with a larger mass of residual cancer, even among those who require extensive surgery.
Recent research has indicated that surgeon tendency and more aggressive surgery in eligible women leads to improved survival in ovarian cancer. In addition, surgery performed by a gynecologic oncologist results in superior outcomes compared to surgery by other types of physicians or surgeons.
Since long-term survival rates for patients with ovarian cancer are poor, research continues to evaluate different surgical measures and associated outcomes among these women.
Researchers from the Memorial Sloan-Kettering Cancer Center in New York recently conducted a clinical trial to evaluate the effects of extensive surgery on outcomes among women with advanced ovarian cancer. Participants in this trial had advanced ovarian cancer (cancer that has spread from the ovary to different sites in the body). They had undergone surgery at Memorial Sloan-Kettering Cancer Center between 1998 and 2003.
This trial included 262 patients and was divided into three groups: group 1 (57 patients) required extensive surgery into the upper abdomen to achieve optimal cytoreduction; group 2 (122 patients) achieved optimal cytoreduction with standard surgical techniques; group 3 (83 patients) were not optimally cytoreduced (cancer greater than 1 centimeter in diameter remained in the body following surgery). At a follow-up of 3 years, the following results were reported:
- Progression-free survival was nearly identical (between 23 and 24 months) for patients in groups 1 and 2; progression-free survival was 11 months for patients in group 3.
- Median survival had not yet been reached for patients in group 1; median survival was 84 months for patients in group 2 and 38 months for patients in group 3.
The researchers concluded that these results provide further evidence that achieving optimal cytoreduction, even through extensive surgery, significantly improves survival for patients with advanced ovarian cancer. Patients in this trial who required extensive surgery extending into their upper abdomen to achieve optimal cytoreduction experienced significantly improved survival compared to patients who were not optimally cytoreduced.
Patients with ovarian cancer may wish to speak with their physician about the individual risks and benefits of optimal cytoreduction.
Reference: Eisenhauer E, Abu-Rustum N, Sonoda Y, et al. The Addition of Extensive Upper Abdominal Surgery to Achieve Optimal Cytoreduction Improves Survival in Patients with Stages IIIC-IV Epithelial Ovarian Cancer. Gynecologic Oncology. 2006; 103: 1083-1090.
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