The role of aggressive surgery in the treatment of ovarian cancer

 

Comment to paper: Aletti GD et al.: "Aggressive surgical effort and improved survival in advanced-stage ovarian cancer", 
Obstet Gynecol. 2006 Jan;107(1):77-85.

 

1) What would you say are the key findings of the study? 
 
Residual disease at the conclusion of the first surgery independently correlates with overall surival, regardless of whether radical or extended surgical procedures were needed.
 
2) How does this differ to previous research about the role of aggressive surgery in the treatment of ovarian cancer? 
 
It is larger than most of the prior studies and we had the luxury of having a large number of surgeons operating where there was some individual variation in the tendency to use radical procedures.  We could therefore look at overall survival by the tendency to use radical procedures and saw a markedly improved survival.   That is a unique comparison of a more vs. less aggressive approach.
 
 3) What are the clinical implications of your findings? 
 
If patients can tolerate (medically speaking) a long operation and it will result in near complete tumor reduction in ovarian cancer, that should be done.  Surgeons performing these types of operations should evaluate their own practices and determine there rates of complete and optimal cytoreduction and look for areas of improvement as we have done.
 
Comments provided by:

William A. Cliby, M.D.,Mayo Clinic Gynecologic Oncologist