Irish research shows multidisciplinary surgical approach to advanced ovarian cancer significantly reduces mortality and progression of disease

 A multidisciplinary surgical approach implemented at the Mater Hospital, Dublin, has improved outcomes for women with advanced ovarian cancer to the extent that patients are approximately 70 per cent less likely to die three years post-surgery.

The new study published in the Annals of Surgical Oncology, which also noted a decrease in rates of disease progression, compared the outcomes of two cohorts of patients diagnosed with advanced ovarian cancer and treated at the Mater Hospital over two different time periods.

In 2017, the hospital’s Department of Gynaecological Oncology adopted a multidisciplinary surgical approach to patients with advanced ovarian cancer, which has allowed for greater rates of cytoreduction, or complete removal of all sites of cancer within the abdominal cavity. In order to combat late-stage disease, the collaborative multidisciplinary environment allows for gynaecological oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal surgeons to carefully plan surgical resections and subsequent treatment. These types of complex surgeries involve multiple specialists and can take up to 10 hours to perform.

Mr Jürgen Mulsow, Consultant General and Colorectal Surgeon at the Mater, said: “As part of our multidisciplinary approach to advanced cancer, we at the Mater Hospital collaborate with colleagues to select the most suitable patients for surgery. This collaboration ensures that patients receive integrated medical care from the moment of consideration of surgery to full recovery and has helped us to improve both peri-operative and long-term outcomes.”

The Mater team previously published the results of an associated study in 2021 on the initial implementation of the multidisciplinary surgical approach. This second paper reports on changes in overall survival, progression-free survival, and complete cytoreduction rates in the five-year period after the implementation of the multidisciplinary surgical team.

In this study, cohort A was a retrospectively collated cohort from 2006 to 2015 of 146 patients with stage III/IV ovarian cancer. Cohort B was a prospectively collated cohort of patients from January 2017 to September 2021 of 174 patients with stage III/IV ovarian cancer.

The study results show that the rate of primary cytoreductive surgery increased from 38 per cent (55/146) in cohort A to 46.5 per cent (81/174) in cohort B. Complete macroscopic resection increased from 58.9 per cent (86/146) in cohort A to 78.7 per cent (137/174) in cohort B (p<0.001). At three years, 75 per cent (109/144) of patients had disease progression in cohort A compared with 48.8 per cent (85/174) in cohort B (log-rank,p<0.001).

Ovarian cancer is a complicated disease that requires input from multiple specialties including medical oncology, pathology, radiology, and surgery

Also, at three years post-surgery, 64.5 per cent (93/144) of patients had died in cohort A compared with 24 per cent (42/174) of cohort B (log-rank,p<0.001). Cox multivariate analysis demonstrated that multidisciplinary team input, residual disease, and age were independent predictors of overall [HR 0.29, 95% CI 0.203–0.437, p<0.001] and progression-free survival [HR 0.31, 95% CI 0.21–0.43, p<0.001]. Major morbidity remained stable throughout both study periods (2006–2021).

The study marks a positive step in the treatment of ovarian cancer, which is the seventh most prevalent female cancer globally and frequently presents at an advanced stage due to lack of symptom awareness. Historically, survival rates for ovarian cancer in Ireland have significantly lagged behind our European neighbours.

Senior author of the study, Prof Donal Brennan, Consultant Gynaecological Oncologist at the Mater Hospital and Professor of Gynaecological Oncology at UCD School of Medicine, said: “Ovarian cancer is a complicated disease that requires input from multiple specialties including medical oncology, pathology, radiology, and surgery. Extensive surgery is often required and we believe that collaboration between different surgical specialities allows us to safely perform aggressive operations to remove all visible tumours from the abdomen, which is the single greatest predictor of improved survival. The study supports the growing body of international evidence that patients with ovarian cancer have better outcomes when managed in centralised specialised oncology centres, such as the Mater.”

The UCD Gynaecological Oncology Group at the Mater Hospital has been certified as a centre of excellence for ovarian cancer in Europe. To date, as the National Centre for Peritoneal Malignancy and home to the largest ovarian cancer unit in the UK and Ireland, the Mater Hospital has performed more than 250 major cytoreductive surgeries on patients with advanced ovarian cancer.

Reference

Mulligan K, Corry E, Donohoe F, Glennon K, Vermeulen C, Reid-Schachter G, et al. Multidisciplinary surgical approach to increase survival for advanced ovarian cancer in a tertiary gynaecological oncology