Friday, May 15, 2015
Over the past 15 years, the ovarian cancer surgical program at Memorial Sloan Kettering Cancer Center has demonstrated extraordinary expertise in numerous ways, including:
- the safe and effective use of minimally invasive surgery to stage early disease
- the benefits of video-assisted thoracic surgery to evaluate patients with advanced-stage disease and pleural effusions
- improved survival rates achieved by incorporating extensive upper abdominal surgical procedures into our surgical armamentarium
- the benefits of a complete gross resection as the optimal goal of primary cytoreduction
- the development of selection criteria that can be used to determine appropriate candidates for secondary cytoreduction for recurrent disease
To further enhance the surgical care we provide for our patients with ovarian cancer, we have formed the Section of Ovarian Cancer Surgery within the Gynecology Service at MSK. The goal of this section is to provide state-of-the-art surgical care with the best possible clinical outcomes and the least morbidity.
For malignancies treated with complex surgical and medical procedures, numerous studies have shown that the best clinical results are attained with management by specialized expert clinicians in high-volume centers. In fact, the disease-specific survival for women with stage IIIC and IV ovarian cancer has been found to be optimized when high-volume physicians take care of patients at high-volume hospitals. (1) Our group exemplifies this approach.Back to top
This new section at MSK is composed of gynecologic oncologists from the Department of Surgery — each of whom brings a specific area of focus and expertise — and is supported by a dedicated ovarian cancer clinical research fellow and several research study assistants. The group, which includes myself and Drs. Yukio Sonoda, Douglas Levine, Ginger Gardner, Kara Long Roche, and Oliver Zivanovic collaborates closely with other members of our Gynecology Disease Management Team.Back to top
Beyond delivering the best patient care possible, the Section of Ovarian Cancer Surgery is deeply committed to advancing the field of ovarian cancer research and treatment. My personal research has focused on determining appropriate candidates for extensive primary debulking surgery (PDS) as opposed to neoadjuvant chemotherapy. (2) We recently published the results of a prospective multicenter trial evaluating the ability of preoperative CT scan and CA-125 to predict suboptimal (>1 cm residual) PDS for patients with advanced ovarian cancer, and developed a model predictive of a suboptimal outcome. (3) We also evaluated the ability of these modalities to predict any gross residual disease after PDS; our findings were discussed as an oral plenary presentation at the 2015 Annual Meeting of the Society of Gynecologic Oncology. We are currently in the process of developing and validating an algorithm for patients with advanced ovarian cancer that triages them to undergo PDS, laparoscopic evaluation of resectability, or neoadjuvant chemotherapy. We believe this algorithm will further increase our rates of optimal and complete primary cytoreduction while minimizing laparotomies for patients whose disease is not amenable to optimal debulking.
Additional research endeavors under way at MSK include a focus on preoperative thromboprophylaxis (Dr. Yukio Sonoda), biomarker development and precision medicine (Dr. Douglas Levine), hyperthermic intraperitoneal chemotherapy and intraoperative fluid management (Dr. Oliver Zivanovic), early detection with novel techniques and management of high-risk women (Dr. Kara Long Roche) and management algorithms for patients with recurrent disease and malignant bowel obstructions (Dr. Ginger Gardner).Back to top
Our team remains highly dedicated to conducting clinical trials, initiating performance improvement projects — such as decreasing our surgical site infection rates and reducing postoperative length of stay — and implementing novel approaches that will continue to improve upon our already successful outcomes.
The summary I’ve provided presents only a snapshot of our efforts to improve outcomes at every stage and in every aspect of the clinical and surgical care of our ovarian cancer patients. Our team is tremendously excited about the opportunity to make substantial, durable, and profound contributions to the challenging field of ovarian cancer surgery.Back to top