Surgery for Ovarian Cancer Involving the Diaphragm
According to a recent article published in Gynecologic Oncology, the removal of cancer spread to the diaphragm in women with 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 have no residual cancer mass larger than 1 centimeter in diameter following surgery (referred to as “optimal cytoreduction”) tend to have better survival than those with a larger mass of residual cancer.
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 dismal, research continues to evaluate different surgical measures and associated outcomes among these women.
Researchers from the Mayo Clinic recently analyzed data regarding outcomes of women with ovarian cancer that had spread to the diaphragm (muscular membrane separating the chest and thorax). Data included over 244 patients with advanced (stages IIIC or IV) ovarian cancer who were primarily treated at the Mayo Clinic in Rochester, Minnesota, between 1994 and 1998. Of these patients, 181 had cancer spread to the diaphragm.
- Among all patients, the amount of remaining residual disease was the only factor associated with survival (less residual disease resulted in improved survival).
- Among patients whose cancer has spread to the diaphragm, patients who underwent removal of cancer of the diaphragm had a 5-year overall survival rate of 53%, compared to only 15% for those who did not undergo the surgical removal of cancer spread to the diaphragm.
- Among patients with cancer spread to the diaphragm who had less than less than one centimeter of residual disease in the pelvis or abdomen following surgery, those whose surgeon removed cancer spread to the diaphragm had a 5-year survival rate of 55%, compared to only 28% for those whose surgeons did not remove cancer spread to the diaphragm.
The researchers concluded that among patients with ovarian cancer whose cancer has spread to the diaphragm, the surgical removal of cancer in the diaphragm results in significantly improved survival at 5 years, even among patients with less than 1 centimeter of residual disease in the pelvis/abdomen. These results provide further evidence that the least amount of remaining cancer following surgery improves survival in patients with ovarian cancer.
Reference: Aletti G, Dowdy S, Podratz K, Cliby W. Surgical treatment of diaphragm disease correlates with improved survival in optimally debulked advanced stage ovarian cancer. Gynecologic Oncology. 2006:100; 283-287.
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