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Mary Kathryn Abel, MD, MAS




Clinical Fellow




Resident Physician


Obstetrics & Gynecology


Mary Kathryn Abel MD, MAS*, Ellen L. Myers, MD*, Ellen Minkin*, Peggy Tahir, MLIS, MA*, Alex Haynes, MD, MPH*, Jason D. Wright, MD*, J. Alejandro Rauh-Hain, MD, MPH*, Alexander Melamed, MD, MPH*

Cancer-directed surgery in patients with metastatic cancer: A systematic review and meta-analysis of randomized evidence

I am honored to participate in the Women in Medicine & Science Symposium. The event brings together the top research minds at MGB and promotes the excellent and practice-changing work of women faculty and trainees. By doing so, the group fosters a network of women for future academic endeavors and mentorship that I hope to engage with during my residency and beyond.

My research and clinical interests include evaluating surgical outcomes in GYN Oncology and breast surgery, improving the care of patients with invasive lobular carcinoma of the breast, and assessing pregnancy and IVF outcomes in patients diagnosed with cancer.

Background: To assess the impact of primary-site surgery plus systemic therapy compared to systemic therapy alone on overall survival in common metastatic cancer types.

Methods: Data sources included Embase, PubMed, and Web of Science (1/1/1995-6/17/2020). Randomized controlled trials were included that enrolled patients diagnosed with the ten most common de novo metastatic cancer types in the Surveillance, Epidemiology, and End Results (SEER) database and randomized patients to resection of the primary site and systemic therapy vs. systemic treatment alone. Random-effects models were used to pool associations by cancer type.

Results: Eight studies with 1,774 patients evaluating the efficacy of surgery in breast, renal, stomach, and colorectal cancer were included. There was no statistically significant reduction in risk of all-cause mortality associated with surgical intervention for metastatic breast (HR=0.94, 95% CI 0.63-1.40) or renal cancer (HR=0.79, 95% CI 0.53-1.20), although results were heterogeneous (I2=73.7% and 80.6%, respectively). One study evaluating gastrectomy in metastatic stomach cancer found no benefit (HR=1.09, 95% CI 0.78-1.52), while a small trial suggested that surgery and hyperthermic intraperitoneal chemotherapy might be beneficial for colorectal cancer with peritoneal metastasis (HR=0.55, 95% CI 0.32-0.95).

Conclusions: Few randomized trials have evaluated cancer-directed surgery among patients with metastatic solid malignancies.