The surgical management of women with ovarian cancer in the south west of England

Abstract

SummaryThe surgical management of epithelial ovarian cancer in the South West of England was studied in the two years 1997-1998 in order to determine the factors that influence the outcome of surgery and to provide a baseline from which to assess the effect of centralisation of cancer services. All hospitals in the South West region of England participating in the Regional Cancer Organisation's longitudinal study of outcomes in gynaecological malignancies are included. Six hundred and eighty-two patients with epithelial ovarian cancer were registered with the RCO in the two-year study period. Five hundred and ninety-five women were offered primary cytoreductive surgery of which 438 were said to be optimally cytoreduced. Applying multivariate models to analyse the outcome of surgery, older patients (OR = 0.82 per 5-year increase in age, P = 0.0003), patients treated in hospitals managing fewer than ten cases of ovarian cancer per year (OR = 1.92, P = 0.02) and patients with FIGO stage 3 (OR = 0.02, P < 0.0001) or 4 (OR = 0.002, P < 0.0001) disease were less likely to be optimally cytoreduced. Gynaecological oncologists were 2.06 times more likely to attain optimal cytoreduction when compared to general gynaecologists and this was statistically significant (P = 0.01). The results from this study support the argument that limiting surgery for ovarian malignancy to specialised surgeons improves the extent of cytoreductive surgery. prior to the re-organisation of gynaecological cancer services, looking particularly at factors influencing the completeness of surgery at each stage of disease. This study, as well as providing a base-line against which future performance can be measured, enables us to estimate the increase in work load and the resource implications for the regional cancer centre if centralisation of ovarian cancer management is fully implemented. MATERIALS AND METHODSThe South and West Regional Cancer Organisation (RCO) Gynaecology Tumour Panel is constituted of a multidisciplinary team of experts involved in the management of gynaecological malignancies. In 1997, the RCO initiated a prospective longitudinal study of the management of gynaecological cancer to establish current patterns of care and facilitate development of services in the region (Jackson et al, 1997). A one-page minimum data-set for each major gynaecological cancer site was designed (Figure 1). After obtaining approval from all units managing gynaecological malignancies, copies of the minimum data set pro forma were circulated along with guidance notes that included outlines of American Society of Anesthesiologists (ASA) grading, FIGO staging, and histopathology information required. Treatment policies detailing accepted pre-operative and operative management of epithelial ovarian cancer were produced and circulated by the RCO to all participating hospitals (Appendix 1). To ensure uniform histopathological reporting, the RCO also circulated guidelines for participating histopathologists (Appendix 2). The clinician managing the case is re...

Effects of Access to and Treatment in Specialist Facilities on Survival From Epithelial Ovarian Cancer in Australian Women: A Data Linkage Study

“…15 Patient volumes may be 1 reason for these survival difference; hospitals managing fewer than 10 patients with ovarian cancer per year have been found not to provide optimal cytoreduction. 16 The average numbers of cases for all GOS hospitals was 14 per annum. Mercado et al 6 also found that patients had lower hazard of death when treated in higher volume hospitals over and above the lower hazard that resulted from surgery.…”

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“…In recent years, several studies support the role of a gynaecological oncologist who is specifically trained in such aspects of care and who can obtain optimal cytoreductive surgery in patients with ovarian carcinoma [12,13]. Therefore, it would seem that an experienced and appropriately trained gynaecological oncologist might achieve a complication rate for patients undergoing radical hysterectomy comparable with that reported by "general gynaecological surgeons..…”

Preoperative predictors of suboptimal primary surgical cytoreduction in women with clinical evidence of advanced primary epithelial ovarian cancer

“…Most recent reports regarding the percentage of women with advanced stage EOC who were optimally debulked at primary surgery lie between 20 and 60% (26)(27)(28)(29)(30)(31)(32)(33) . However there is variation in the definition of optimal cytoredution in terms of maximum diameter of residual disease, which accounts for some of the variation in rates reported in the literature.…”