When and Who Should Perform Epithelial Ovarian Cancer Surgery?

Abstract

Epithelial ovarian cancer is the most common cause of death due to gynecologic malignancies. Most patients will be diagnosed at an advanced stage, and despite progress in both surgical procedures and novel targeted therapies, the overall survival of these patients remains very low. Among prognostic factors, the International Federation of Gynecology and Obstetrics stage and residual tumor after debulking surgery are the most widely reported. The current review aims to highlight the disparities in the treatment of patients with ovarian cancer and the need for postgraduate training programs in order to accredit gynecologic oncologists. Despite an increase over the centralization of these patients, many are still not receiving specialized surgery.

Patient and Provider Perspectives on Barriers to Accessing Gynecologic Oncologists for Ovarian Cancer Surgical Care

“…3,[9][10][11][12][13] Despite the evidence of improved outcomes and NCCN recommendations, as many as 30% of women with ovarian cancer in the United States and nearly 15% of women in Iowa are not receiving surgical care from a gynecologic oncologist. 11,[14][15][16][17][18][19][20] Researchers have hypothesized this discrepancy between recommended and received care is due to the incidental diagnosis, discovery of cancer during non-cancer surgery and disagreement about standards of care. 21,22 Low referral rates may also be associated with receipt of care at a rural hospital or a low-volume hospital, and lower patient income or a lack of insurance.…”

Ovarian cancer: Is an expert surgical oncologist mandatory?

“…Most importantly, the skills of SOs may depend on the number of OC operations performed, obtaining a dedicated learning curve required for the improvement and the maintenance of their skills (15,30,38).…”

“…The primary goal of OC surgery should be the complete resection of all macroscopic disease or, if this is not possible, the smallest resection of the residual disease (15).…”

“…Consequently, the observed survival advantage may result from more aggressive surgeries done by SOs, allowing maximal cytoreductions (15,18).…”

“…To achieve a complete cytoreduction, aggressive surgical techniques should be performed, including bowel resection and anastomosis, urologic procedures, diaphragm peritonectomy and upper abdominal resection (15).…”