WellSpan Gynecologic Oncology: Improving Outcomes through Advanced Surgical Approaches

By Brittain Whiteside-Galloway
Friday, March 24, 2017

Specialists at WellSpan Gynecologic Oncology unite multidisciplinary expertise with leading-edge surgical techniques to provide additional treatment options that improve cancer patients’ survival rates and quality of life.

A surgical team at WellSpan York Hospital prepares the operating room for a gynecology surgery using the da Vinci Surgical System.

Ovarian cancer is one of the most lethal cancers in women and claims more lives than any other cancer of the female reproductive system. This stems in part from the fact that symptoms — which include abdominal swelling or bloating, pelvic pressure or pain, poor appetite, and urinary urgency and frequency — often do not present until the disease is in its later stages, when it’s most difficult to treat. A lack of reliable screening methods compounds that problem.

WellSpan Gynecologic Oncology responds to these challenges with a variety of life-extending interventions.

Radical Reduction

Surgery is the keystone of treatment of ovarian cancer. In particular, cytoreductive surgery — which sharply reduces the volume of cancerous cells — is one of the best standard-of-care management strategies for combating early- and advanced-stage epithelial ovarian cancers, as well as some cases of metastatic endometrial cancer.

Cytoreduction entails an initial evaluation via laparotomy to collect tissue for definitive diagnosis of the subtype of ovarian cancer the patient has, as well as to remove as many cancerous cells as possible if the surgeon deems the patient to be a candidate for optimal reduction.

“The ultimate goal of cytoreductive surgery is to achieve microscopic to no visible disease,” says Mark Miller, DO, fellowship-trained gynecologic oncologist, Director of Gynecologic Oncology, WellSpan Health. “However, if the patient’s disease volume is too advanced to achieve optimal cytoreduction, we typically administer neoadjuvant chemotherapy to reduce the cancer volume before following up with a repeat exploratory laparotomy, in hopes that cytoreduction can then be performed.”

Cytoreductive surgery involves removal of the cervix, uterus, fallopian tubes and ovaries — and potentially the rectosigmoid and peritoneum of the abdominal and pelvic cavities, as well as a splenectomy, omentectomy and small bowel resection, Dr. Miller explains.

While some patients undergo three cycles of neoadjuvant chemotherapy before cytoreductive surgery, the procedure is often performed before chemotherapy is given.

Clinical research has shown patients who undergo the procedure enjoy a significant survival benefit. A 2015 review in Journal of Gynecologic Oncology notes that “aggressive surgical cytoreduction can offer the best opportunity for achieving extended survival in women with advanced ovarian cancer.” Moreover, it is clinically demonstrated that outcomes are better when a gynecologic oncologist, rather than a general surgeon, performs the procedure, Dr. Miller adds.

“Numerous studies have indicated cytoreduction provides high potential for progression-free survival,” Dr. Miller says. “With some cancers, surgery isn’t recommended in stages 3 and 4, so patients’ treatment options are typically reduced to chemotherapy and/or radiation therapy. That’s not the case with ovarian cancer — women can and do live longer after this surgery, even if all the cancer isn’t removed. Reducing volume to microscopic levels in patients with recurrent disease can in some cases extend survival beyond 72 months. That is phenomenal when you consider where treatment was 20 years ago, when the majority of patients with recurrent disease died within 36 months.”

Cytoreduction also addresses chemotherapy resistance. Because it can be difficult or impossible to remove all cancer cells in advanced stages of ovarian cancer — and late-stage ovarian cancers have a high rate of recurrence — the majority of patients who undergo cytoreductive surgery follow up with chemotherapy to help kill remaining malignant cells.

“A chief problem with chemotherapy is that cancer cells can become resistant to the therapy, so undergoing cytoreductive surgery beforehand can help minimize the work chemotherapy has to do, ‘finishing the job,’ so to speak, before resistance occurs,” Dr. Miller says.

“We have the capabilities of an academic medical center, yet we are in a community hospital setting. The care we provide to patients locally is on par with that of major university facilities and is focused on the patient and family.”
— Mark Miller, DO, fellowship-trained gynecologic oncologist, Director of Gynecologic Oncology at WellSpan Health

Fertility-sparing Surgery

Another advanced procedure Dr. Miller and his team perform is uterine preservation surgery.

“This procedure is for women of childbearing age who are diagnosed with certain germ-cell tumors and borderline tumors of the ovary for which a unilateral staging could be performed,” Dr. Miller says. “The primary benefit is preservation of the uterus and the opposite ovary and fallopian tube so as to spare the patient’s fertility.

“For appropriate candidates, leaving the uterus and the opposite ovary in place does not compromise curability of the cancer. Approximately 90 to 95 percent of our patients who have had uterine preservation surgery have a positive outcome.”

A Comprehensive Effort

“The key to achieving excellent outcomes from these surgeries is our multidisciplinary approach to patient care,” Dr. Miller says. “For example, our tumor board consists of a team of highly trained specialists, including pathologists and medical, radiation and surgical oncologists, who meet at our weekly pathology conference to discuss each patient’s case and collaboratively decide on the wisest courses of action. These providers and other clinicians — everyone from our nurses to our outstanding anesthesia staff to our top-notch ICU — work together to ensure patients receive the best care possible.”

WellSpan also heavily emphasizes caring for patients’ families.

“If you support the family, you’re also supporting the patient,” Dr. Miller says. “It’s ultimately the patient’s family who is going to see her through her battle with ovarian cancer and her recovery from surgery.”

Partnering with referring primary care physicians and OB/GYNs is a priority as well.

“It’s absolutely essential,” Dr. Miller says. “Our relationships with our colleagues in the community have helped us build a robust program that is making a tremendous difference in the health of women around the region.”

To refer a patient to WellSpan Gynecologic Oncology, call 717-851-6120. To learn more about WellSpan’s oncology services, visit WellSpan.org/Oncology.