Women with ovarian cancer will have better outcomes if they have more complete removal of their cancer, according to a report in the Journal of Clinical Oncology (Vol. 20, No. 5: 1248-1259).

Even if a woman’s cancer can’t all be removed, she will have a better chance for survival if the surgeon can cut out enough so that the remaining tumors are no bigger than 2 cm. (0.8 inches). This process of removing most of the cancer is called cytoreductive surgery.

In about 75% of cases the cancer will have spread outside the ovary. If the surgeon doesn’t remove most of the cancer, the chances of survival are lowered, according to Robert E. Bristow, MD, and his colleagues from Johns Hopkins Medical Institutions in Baltimore, Md.

If a gynecologist tells a woman that she has a tumor in her ovary and that she needs surgery, she will have to make a crucial decision to make. Should she have the gynecologist remove the tumor? If the tumor is benign, there is no problem. But if it is malignant, she might have made a mistake that could cost her years of life.

The researchers reviewed 53 separate studies involving 6,885 patients. Bristow separated the surgeons by how often they were able to remove enough cancer so that only tumors less than 2 cm remained.

Women treated by surgeons who were able to do this over 75% of the time lived three years, on average. Women treated by surgeons who were successful only 25% of the time or less had an average survival of only two years.

All of the women also received chemotherapy with the standard drugs of the last decade, cisplatin or carboplatin combined with other chemotherapy drugs. The dosages of these drugs did not affect survival.Finding a Gynecologic Oncologist Is Critical

Most of the time the surgeons who are achieving good results are gynecologic oncologists, specialists in treating cancers of the female genital system. They have also been specially trained in cytoreduction of ovarian cancers.

The researchers looked at exactly how much successful surgery improved survival. They found that if the surgeons could increase their success rate in a group of women by 10%, then the average survival of that group would increase by 5.5%.

Other studies have shown that general surgeons or gynecologists are only able to remove most of the cancer 20% to 30% of the time. Gynecologic oncologists are successful around 75% to 80% of the time.

Most women with advanced ovarian cancer are not referred to these specialists. Bristow cites a study from Utah that found that gynecologic oncologists treated only 39% of women with ovarian cancer. The highest percent of those treated by the specialists lived in urban settings.

Bristow said that in the setting where all women with ovarian cancer get effective chemotherapy, the quality of the surgery equates with her survival.

"Consistent referral of patients with advanced ovarian cancer to expert centers for initial surgery may be the best means available for improving overall survival," Bristow wrote.

Ovarian cancer will be diagnosed in about 23,000 women in 2002, according to the American Cancer Society.