Does surgery or second look laparoscopy improve prognosis?

Dear Dr. Goodman:

This is a follow up to my previous post re my wife's recurrence. She (52 yrs old) had a first complete surgery last June/05. We told our onc as to a possible surgery to remove a remaining small isolated mass of 1.3 X 0.8 cm in the abdomen ( a density adjacent to the posterior margin of the ascending colon) and she said: there is no study that shows surgery improves prognosis. This is after 6 cycles of doxil and her CA 125 has been normal since the 2nd treatment (9). It was 300 when it recurred.

Is there really no study that shows 2nd debulking or laparoscopy improves prognosis?

Thank you again for your answer.

Jatoo

[Annekathryn Goodman, M.D.]

Dear Jatoo,
Thank you for your excellent question. First I would like to be philosophical. I feel that each person is unique. The challenge of giving excellent care and making appropriate treatment recommendations has to do with balancing data, studies, science, with the unique human being with their unique story. If we ignored data, that would be wrong. If we blindly treated people according to data but without looking at the individual, that would be wrong as well. Sometimes, there are no wrong answers. There are many possible approaches; none of them are perfect. And one just needs to decide with the help of the person who is going through the illness what is the best choice.
I need to stress, that without seeing your wife or the x-rays, I cannot comment on whether

[Jatoo]

Sorry. I think the correct terminology is 2nd look laparotomy. Thanks.

[sueg]

THanks Dr.Goodman and jatoo for posting this question.It's confirmed what my gyn/ob decided with me-no surgery until its needed and I feel comfortable with that.
Sue x

[Jatoo]

Dear Dr. Goodman:

Thank you very much for a very magnanimous and stupendous answer. I'm sorry that I am only able to thank you now because we were on some sort of a holiday at the same time attending a convention in San Francisco and we just arrive past midnight last night and was very glad when I saw your response.

I was not surprised of how you answer, which is like that of a lawyer, basing it from your previous responses to other questions. But your research is what strucked me after spending myself so much time on the web trying to find answers. I have never seen such data like that and most probably other oncs too. If my onc would have known those data she probably would have said differently. That's why we were seeking a second opinion from a surgeon ob gyn onc. My wife is still relatively young, that's why they wanted to be aggressive on her. But please be aggressive in the right way. My friend onc (not my wife's) told me also about surgery which he said is the current trend. If they can remove that small isolated mass and keep her in remission for so long based on the data you gave me, then so be it.

I wish oncs where like you who knows very much about the ways of curing this disease. I wish oncs like you can put your heads together so that at the very least we can recommend a correct path towards a meaningful cure. Thank you.

Jatoo

[Jatoo]

Dear Sue:

All the best to you. Keep posting, we may just yet struck gold. Thanks.

Jatoo