Multidisciplinary Surgical Approach Leads to Decreased Morbidity Rates in Ovarian Cancer

At a 3-year analysis, 75.0% of patients in cohort A and 48.8% of patients in cohort B experienced disease progression (P< .001).

Patients with advanced ovarian cancer are 70% less likely to die 3 years after receiving aggressive, multidisciplinary surgery, according to results of a study conducted by researchers at the Mater University Hospital.¹

Specifically, results showed that the death rate decreased from 64.5% to 24% with the implementation of multidisciplinary surgical treatments. The multidisciplinary approach was comprised primary or interval cytoreductive surgery (CRS), defined as complete resection of all macroscopic disease. The investigators noted that CRS has been linked with significant improvements in survival.

“Ovarian cancer is a complicated disease that requires input from multiple specialties including medical oncology, pathology, radiology and surgery,” Donal Brennan, professor of gynecological oncology at UCD School of Medicine and consultant gynecological oncologist at the Mater University Hospital, said in a press release regarding the study.² “We believe that collaboration between different surgical specialties allows us to safely perform aggressive operations to remove all visible tumors from the abdomen, which is the single greatest predictor of improved survival.”

The study included data from two cohorts. Cohort A was based off a previously published study and comprised of 146 patients with stage III/IV ovarian cancer, while cohort B included 174 patients who had stage III or greater disease.¹

The median age across both cohorts was 60.5 years (range, 28-90); 76% of patients had stage III disease and 23.9% had stage IV disease. In cohorts A and B, respectively, 38.0% and 46.5% were offered primary cytoreduction and 62% and 53.4%, respectively, had interval cytoreduction. The average number of patients presenting with advanced disease was 15 and 33 in each respective cohort. Median follow-up was 60 months in cohort A and 48 months in cohort B.

The primary end points for this trial included progression-free survival (PFS) and overall survival (OS).

At a 3-year analysis, 75.0% of patients in cohort A and 48.8% of patients in cohort B experienced disease progression (P< .001).

A survival analysis of patients who received primary and interval CRS was conducted in order to assess the relationship between CRS and survival.

Additional data from a Cox multivariate analysis showed that a multidisciplinary surgical team input, residual disease, and age were independent predictors of OS (HR, 0.29; 95% CI, 0.203-0.437; P < .001) and PFS (HR, 0.31; 95% CI, 0.21-0.43; P < .001).

In patients who underwent primary CRS, 68.5% of patients in cohort A and 48.0% of patients in cohort B had disease progression at 3 years (P = .031). In the same patient subset, 59.0% of patients in cohort A and 20.9% of patients in cohort B died at the 3-year analysis (P < .001).

In patients who underwent interval CRS, 80.0% of patients in cohort A and 50.0% of patients in cohort B had disease progression at 3 years. In the same patient subset, 67.0% of patients in cohort A and 28.0% of patients in cohort B died (P < .001).

The overall major morbidity rate was 18.0% in cohort A and 14.9% in cohort B. Postoperative complications in cohort A included hemorrhage (n = 4), pelvic collection (n = 3), postoperative infection (n = 5), death (n = 1), and other (n = 12). In cohort B, the most common postoperative complications included ileus (n = 5), wound infection (n = 8), pelvic collection requiring interventional radiology (IR) drainage (n = 7), and pleural effusion requiring IR drainage (n = 5).

“Our multidisciplinary approach has resulted in improved progression-free and overall survival likely due to a high rate of both optimal and complete cytoreduction with a relatively stable morbidity rate over a 5-year period,” the authors wrote in the study. “The impact of a multidisciplinary, surgical approach is in our opinion that it fosters a collaborative approach and facilitates the implementation of a more aggressive surgical philosophy in carefully selected patients.”

References

1. Mulligan K, Corry E, Donohoe F, et al. Multidisciplinary surgical approach to increase survival for advanced ovarian cancer in a tertiary gynaecological oncology centre. Ann Surg Oncol. 2024;31(1):460-472. doi:10.1245/s10434-023-14423-1
2. Ovarian cancer patients 70% less likely to die with aggressive surgical approach. University College Dublin. News release. October 27, 2023. Accessed January 10, 2024. http://tinyurl.com/y9y9tevt