Nov 23, 2005 - 3:17 am
It is recommended that patients with ovarian cancer undergo aggressive de-bulking surgery up front, prior to chemotherapy. It has long been observed that those patients whose tumors can be resected without any visible residual disease tend to live longer than those who are left with residual tumor after de-bulking surgery. Based upon this, up front, de-bulking surgery has become the standard of care.
Some researchers believe the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive, and that the removal of lymph nodes at the time of surgery may additionally contribute to a better outcome.
A study from Germany tested the role of surgery in patients with recurrent ovarian cancer and found that those patients who underwent resection without any residual tumor did better than those whose tumors could not be completely removed. The authors of this study identified four parameters that could predict the possibility of complete resection, which included:
--Good performance status
--No ascites (malignant fluid in the abdomen)
--No residual tumor after the first surgery
--No evidence of peritoneal spread of tumor on the preoperative tests
Patients who met all these criteria had an 80 percent chance of successful surgery with complete tumor removal.
Surgery is an integral part of the multimodality treatment of many cancers. In the case of ovarian cancer, proper patient selection will ensure the benefit of surgery for those who need it and avoid its morbidity and delay in the commencement of chemotherapy for those who are unlikely to benefit from it.