Ovarian Cancer Treatment: Predictors of Comprehensive Surgery

Ovarian cancer is rare, but it is more deadly than other gynecologic malignancies because most ovarian tumors are already advanced at diagnosis. Optimal initial surgical treatment is a key factor in improving ovarian cancer outcomes. In this federally funded U.S. cohort study, investigators evaluated the surgical treatment of more than 10,000 women (mean age, 60; 84% white) who received primary surgical treatment for ovarian cancer from 1999 to 2002 in one of nine states.

Forty-two percent of the patients underwent surgery in teaching hospitals. One third of the patients had surgery in low-volume hospitals (<10 ovarian cancer surgeries annually). Nearly half the patients (48%) were operated on by surgeons who performed fewer than 10 ovarian cancer surgeries each year, with 25% of patients undergoing surgery by very-low-volume surgeons (≤1 ovarian cancer surgery annually). In South Carolina (the only state in which surgeon subspecialist status was available), gynecologic oncologists (GOs) performed 70% of ovarian cancer operations. Patients with primary ovarian cancer who underwent both a lymph node dissection and omentectomy/cytoreduction were considered to have received comprehensive surgery.

Overall, 67% of patients received comprehensive surgery. Factors significantly associated with being less likely to receive comprehensive surgery included age 71 and older, black or Hispanic race, Medicaid funding, surgery performed by a very-low-volume surgeon, and surgery not performed by a GO. Among nonteaching hospitals, operations performed at low-volume facilities were less likely to be comprehensive. Among teaching hospitals, surgery volume was not associated with likelihood of receiving comprehensive surgery.