Who should perform surgery in ovarian cancer?
Prof. Ate van der Zee
47 slide(s) – 00:16:03 – English – 2009-01-23
After viewing this presentation the participant will be able to discuss:
- Epidemiology of ovarian cancer
- Surgery in ovarian cancer: issues
- Gynecologic oncology in the North of the Netherlands
- Findings from a population-based pattern of care study in ovarian cancer patients
In ovarian cancer, the most important prognostic factors are the stage and extent of residual disease after surgery. The timing of aggressive surgery may also be different in patients, so it is recognized that a more individualized approach to surgery should be used, but who should provide this? Prof. van der Zee shows studies comparing outcomes from treatment of ovarian cancer by gynaecologic oncologists versus general gynaecologists, and in teaching versus non-teaching hospitals.
Retrospective population-based studies indicate that treatment by certified gynaecological oncologists results in more optimal debulking and better survival. The meta-analysis of 81 studies published by Bristow et al. supports this, concluding that “consistent referral of patients with apparent advanced ovarian cancer to expert centers may be the most efficient effort currently available for improving survival.”
In the North of the Netherlands, since the 1980s patients with cervical and vulvar cancer are frequently referred to a center, however no referral pattern exists for those with endometrial and ovarian cancer. During this time a study has been ongoing that aims to bring surgical expertise to the community hospitals in order to improve survival by better staging and debulking.
Of interest is the report by Engelen and colleagues comparing the outcomes of primary surgery by gynaecological oncologists compared to general gynaecologists. The retrospective cohort study, which was performed in the Netherlands and published in Cancer in 2006, found that surgical treatment of ovarian carcinoma by gynaecological oncologists significantly improved survival, more often resulted in no residual tumor in stage III, and there was better adherence to surgical guidelines. Prof. van der Zee shows other studies from Europe and the U.S. with similar findings, in addition to associations between hospital type and survival.
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