title: Centralizing surgery for gynecologic oncology--a strategy assuring better quality treatment?
abstract: OBJECTIVE
  The objective of this study was to assess the association between the type of hospital and the previously reported shortcomings in surgical treatment for ovarian and endometrial carcinomas in Hesse, Germany.
  
  
  METHODS
  The types of hospitals)primary, secondary, tertiary and central care referral or university clinic) at which patients with endometrial and ovarian cancer were treated were correlates with the following variables: patients' functional status, tumor stage (FIGO), the performance of lymphadenectomy and/or omentectomy, and the frequency of intraoperative and postoperative complications. Data came from the GQH project, which assessed all diagnostic, surgical, and postoperative gynecologic procedures undertaken in Hesse between 1997 and 2001.
  
  
  RESULTS
  In 1119 cases of endometrial cancer significantly fewer (P < 0.001) lymphadenectomies were performed in primary care hospitals despite the fact that patients treated in primary care hospitals were younger and had a better functional status and lower tumor stage than patients treated in other types of hospitals. In ovarian cancer too, lymphadenectomy rates varied considerably with the type of hospital (P = 0.010) even when the analyses were restricted to patients whose functional status was good (ASA <III) and whose tumor stage was low (FIGO stage <III). However, the analyses still revealed striking shortcomings, even at tertiary care hospitals and central referral hospitals and university clinics where the lymphadenectomy rate ranged around 60%.
  
  
  CONCLUSIONS
  The type of hospital is an important factor in the quality of surgical treatment for endometrial and ovarian cancer. Restricting treatment to experienced specialist surgeons or hospitals offering high treatment standards seems necessary if treatment outcomes are to improve.
authors.affiliation: Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Klinikstrasse 32, D-35385 Giessen, Germany. karsten.muenstedt@gyn.med.uni-giessen.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Münstedt
authors.forename: Richard
authors.initials: R
authors.lastname: von Georgi
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.forename: Marek
authors.initials: M
authors.lastname: Zygmunt
authors.forename: Rosi
authors.initials: R
authors.lastname: Stillger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Künzel
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000145:classification / Q000592:standards*; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D011787:Quality of Health Care