Radical Surgery Best Option For Most Ovarian Cancer Patients With Cancer In Diaphragm

"Surgeons have long believed that removing as much diseased tissue aspossible is important for survival of cancer patients," said WilliamCliby, M.D., associate professor of obstetrics and gynecology at MayoClinic. "The choice of many surgeons to not resect diaphragm disease inovarian cancer patients seemed counterintuitive, but it was based onthe feeling that it might not improve survival. We sought to addressthis issue."

Dr. Cliby's team cited lack of evidence of survival benefit, concernsover safety (related to complexity and length of the surgery) and lackof surgeon experience as justifications often given for not proceedingwith diaphragmatic surgery in advanced ovarian cancer patients. Thisstudy provided strong evidence of survival benefit. The five-yearsurvival rates for patients with diaphragm disease who had optimalresidual disease (less than 1 cm) was 55 percent for those undergoingdiaphragm surgery versus 28 percent for those who did not.

The study group included 244 consecutive patients with primary ovariancancer who were operated on at Mayo Clinic from 1994 through 1998 andfrom Aug. 1, 2002, through Aug. 31, 2004. Dr. Cliby and his colleaguesfound that at Mayo Clinic, the rate of diaphragm procedures foraffected patients increased from 22.5 percent in the first periodcompared to 40 percent in the more recent period. They attribute thisto increased surgeon experience, increased recognition of theimportance of maximal effort for tumor resection and the cooperativeworking relationships with other surgical specialties at Mayo Clinicthat provide the opportunity to train interdepartmentally and improvesurgical techniques. "We hope to continue improving upon our ability toremove cancer disease from all affected areas," said Dr. Cliby. "Witheach operation, our surgeons become better equipped to handle the mostdifficult of surgeries, providing hope for more patients."

The researchers conclude that while health issues in some patients willcomplicate the success of surgery in general, and prevent the option ofradical surgery, surgeons should work to increase the rate of tumorreduction, including diaphragm surgery, in appropriate cases.

In addition to Dr. Cliby, the research team included Giovanni Aletti, M.D.; Sean Dowdy, M.D.; and Karl Podratz, M.D., Ph.D.

For more information about women's cancer research, see the Web site at: http://mayoresearch.mayo.edu/mayo/research/womens_cancer.

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