Big improvement in ovarian cancer outcomes at Mater hospital with aggressive surgical approach

A big improvement in the survival rate from advanced ovarian cancer has been achieved at the Mater hospital in Dublin through the use of aggressive surgery involving multiple specialists.

Women with advanced ovarian cancer were about 70 per cent less likely to die from the disease three years after a multidisciplinary surgical approach was deployed, a study of patients attending the hospital found.

The death rate fell from 64.5 per cent to 24 per cent over the span of a decade after the new approach focusing on the complete removal of all sites of cancer from the abdominal cavity (known as cytoreduction) was adopted.

The rate of disease progression three years after surgery and chemotherapy also fell, from 75 per cent to less than 50 per cent.

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The study, published on Thursday in the Annals of Surgical Oncology, looked at two cohorts of patients – more than 300 in total – diagnosed with advanced ovarian cancer and treated at the Mater from 2006 to 2015 and 2017 to 2021, respectively.

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In 2017, the Mater’s department of gynaecological oncology adopted the multidisciplinary surgical approach that makes use of specialists in medical oncology, pathology, radiology and surgery.

“Ovarian cancer is a complicated disease that requires input from multiple specialties,” said Prof Donal Brennan, consultant gynaecological oncologist at the Mater and professor at UCD school of medicine. “Extensive surgery is often required.”

The collaborative approach allows gynaecological oncologists as well as colorectal, liver/pancreas and upper gastrointestinal surgeons to carefully plan the removal of diseased tissue and subsequent treatment. Operations involving multiple specialists can take up to 10 hours to complete.

The cancer has “nearly always” spread by the time it is diagnosed, Prof Brennan said. “It’s like someone has taken a bag of rice and emptied it into your abdomen. Our job is to remove every grain of rice to stop the cancer spreading.”

The approach has been made possible by the return to Ireland of skilled surgeons trained in specialist centres abroad.

No increase in post-operative complications has occurred.

The results provide further evidence that better outcomes can be achieved through centralisation of surgical services, Prof Brennan said, though chemotherapy should still be administered as close as possible to where patients live.

Ovarian cancer is the seventh most prevalent female cancer globally. In Ireland, about 450 cases are detected each year, of which 300 come to surgery. The Mater unit performs about 80 such operations a year.

Historically, survival rates for ovarian cancer in Ireland have lagged well behind our European neighbours, so the latest results should contribute to a significant catch-up.

Prof Brennan stressed the importance of “changing the narrative” around advanced cancers away from talk of cures. “There’s often the chance a cancer will come back. But with modern treatments, we can get things under control, so people can live productive lives – just as with HIV treatment.”

Case study: ‘It just happened so quickly’

A bloated stomach was the only real symptom Jeannine Davis, from Coolock, Dublin, felt before finding out she had advanced ovarian cancer in May 2017.

Yet, within a week of diagnosis, the then 39-year-old was undergoing a 10-hour operation to remove the cancer.

“My stomach swelled, so in a few weeks it looked like I was heavily pregnant. It just happened so quickly,” she said.

With her cancer within a week of being inoperable, there was no time to lose. Adopting the new multidisciplinary approach, the Mater team painstakingly removed all fragments of the cancer during a painstaking operation. Ms Davis stayed in hospital for a month and was given chemotherapy six weeks after.

“There were days when you didn’t want to get out of the bed, but overall I made a good recovery,” she recalled.

The cancer came back a year later, in her lymph nodes, and was dealt with through more chemotherapy. Ms Davis has been well since, while remaining on a dose of maintenance chemo.

“Everything is back to normal. I receive treatment once every three weeks. A good eye is being kept on me.”

Her advice to other women is to “listen to your body and make yourself aware of the signs of gynaecological cancers. And don’t be afraid to get a second opinion or go back to your doctor”.