Survival rates for Irish women with ovarian cancer are forecast to improve as a result of a new approach involving aggressive surgery by doctors at two Dublin hospitals.
The approach, involving the use of teams of surgeons and oncologists at the Mater and St Vincent’s University hospitals, has already resulted in significantly improved rates of complete resection of the cancer.
Cancer of the ovary has one of the worst survival rates of all cancers, and Ireland’s ovarian cancer survival rates are among the worst in the world.
About 400 women a year are diagnosed with ovarian cancer, which has a five-year survival rate of just 35 per cent.
The new approach using aggressive surgery relies on the fact that ovarian cancer often presents with widespread disease throughout the abdomen. Surgery to remove tumours can often involve removal of multiple organs and the entire peritoneum (the inner lining of the abdominal cavity).
The improvements in outcomes were achieved by employing a multidisciplinary surgical team, comprising gynaecological oncologists beside gastrointestinal and liver surgeons, and also by ensuring the patient is in optimum clinical condition prior to surgery.
Over the past four years, the rate of complete macroscopic resection in women having surgery has increased from 49 per cent to 77 per cent through the use of these surgical teams, according to a study published in the Annals of Surgical Oncology.
Resection
Surgical resection remains the cornerstone of ovarian cancer management, according to Prof Donal Brennan, gynaecological oncologist at the two hospitals. "The goal of surgery in ovarian cancer is to remove all visible disease and this can involve extensive resections including hysterectomy, removal of the ovaries, rectum [and other parts of the bowel], spleen, gallbladder and stripping or resection of the diaphragm.
“Cancer is a microscopic disease, therefore, even if we remove all visible tumour, there may be residual microscopic tumour,” he said.
In the approach adopted by the UCD Gynaecological Oncology Group based at the Mater and St Vincent’s, the right specialist surgeon to conduct each part of the resection is selected to ensure a more sustainable and safer approach to surgery.
Over the period the morbidity rate (complications) has dropped from more than 38 per cent to 31 per cent which, Prof Brennan says, is “less than we would expect” given the aggressive nature of the surgery.
“We do not have survival data on these patients as yet but numerous other studies have proven that this sort of increase in complete resection rates should translate into improved survival.”
