Surgery to remove metastatic disease from the diaphragm, in conjunction with other procedures to remove primary diseased tissue in ovarian cancer patients, significantly increases survival rates, according to an article published online September 20th by Gynecologic Oncology.

“Surgeons have long believed that removing as much diseased tissue as possible is important for survival of cancer patients,” said William Cliby, MD, associate professor of obstetrics and gynecology at Mayo Clinic and lead author of the study. “The choice of many surgeons to not resect diaphragm disease in ovarian cancer patients seemed counterintuitive, but it was based on the feeling that it might not improve survival We sought to address this issue.”

The American researchers cited lack of evidence of survival benefit, concerns over safety related to complexity and length of the surgery, and lack of surgeon experience as justifications often given for not proceeding with diaphragmatic surgery in patients with advanced ovarian cancer. This study provided strong evidence of survival benefit. The five-year survival rates for patients with diaphragm disease who had optimal residual disease (less than 1 cm) was 55 percent for those undergoing diaphragm surgery versus 28 percent for those who did not.

The study group included 244 consecutive patients with primary ovarian cancer who underwent surgery at the Mayo Clinic from 1994 through 1998 and from August 1, 2002, through August 31, 2004. The investigators found that the rate of diaphragm procedures for affected patients increased from 22.5 percent in the first period compared with 40 percent in the more recent period. They attributed this to increased surgeon experience, increased recognition of the importance of maximal effort for tumor resection, and the cooperative working relationships with other surgical specialties at Mayo Clinic that provide the opportunity to train interdepartmentally and improve surgical techniques.

“We hope to continue improving upon our ability to remove cancer disease from all affected areas,” said Cliby. “With each operation, our surgeons become better equipped to handle the most difficult of surgeries, providing hope for more patients.”

The researchers concluded that while health issues in some patients will complicate the success of surgery and prevent the option of radical surgery, surgeons should work to increase the rate of tumor reduction, including diaphragm surgery, in appropriate cases.