title: Who should operate on patients with ovarian cancer? An evidence-based review.
abstract: OBJECTIVE
  To evaluate the relationship between surgical specialty and survival in patients receiving initial surgical management for ovarian epithelial cancer.
  
  
  METHODS
  An analytic framework was constructed to address the principle question 'does the type of surgeon operating on patients with newly diagnosed ovarian epithelial cancer influence survival?' A literature search addressing the components of this analytic framework was carried out using the Cochrane Library, Medline, EMBASE, and HealthSTAR databases. Relevant articles were selected and graded using U.S. Preventive Services Task Force and Canadian Task Force guidelines. Results were summarized by quality as well as level of evidence.
  
  
  RESULTS
  Eighteen studies were reviewed. The quality of evidence was good in 3, fair in 8, and poor in 7 of the studies. The most common study flaws encountered were 'failure to account for confounders' and 'incompleteness of data'. In studies focusing on advanced disease, there was good quality evidence to support a 6- to 9-month median survival benefit for patients operated on by gynecologic oncologists rather than general gynecologists and/or general surgeons (P values 0.009 to 0.01). Studies focusing on early stage disease found gynecologic oncologists more likely to carry out optimal staging (P values 0.001 to 0.01). Increased survival could be explained by improved identification of true stage I patients.
  
  
  CONCLUSIONS
  Patients receiving initial surgical management for ovarian epithelial cancer should be operated on by gynecologic oncologists.
authors.affiliation: University of Toronto, Canada. christopher.giede@usask.ca
authors.forename: Kurt Christopher
authors.initials: KC
authors.lastname: Giede
authors.forename: Katharina
authors.initials: K
authors.lastname: Kieser
authors.forename: Jason
authors.initials: J
authors.lastname: Dodge
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006176:Gynecology / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D008511:Medicine / Q000592:standards; D010051:Ovarian Neoplasms / Q000601:surgery*; D011787:Quality of Health Care; D013038:Specialization