title: Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma.
abstract: BACKGROUND
  Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic oncologist on treatment outcome.
  
  
  METHODS
  The hospital files from 680 patients with epithelial ovarian carcinoma who were diagnosed between 1994 and 1997 in the northern part of the Netherlands were abstracted. Treatment results were analyzed according to the operating physician's education by using survival curves and univariate and multivariate Cox regression analyses.
  
  
  RESULTS
  Primary surgery was performed on 184 patients by gynecologic oncologists, and on 328 patients by general gynecologists. Gynecologic oncologists followed surgical guidelines more strictly compared with general gynecologists (patients with International Federation of Gynecology and Obstetrics [FIGO] Stage I-II disease, 55% vs. 33% [P=0.01]; patients with FIGO Stage III disease, 60% vs. 40% [P=0.003]) and more often removed all macroscopic tumor in patients with FIGO Stage III disease (24% vs. 12%; P=0.02). When patients were stratified according to FIGO stage, the 5-year overall survival rate was 86% versus 70% (P=0.03) for patients with Stage I-II disease and 21% versus 13% (P=0.02) for patients with Stage III-IV disease who underwent surgery by gynecologic oncologists and general gynecologists, respectively. The hazards ratio for patients who underwent surgery by gynecologic oncologists was 0.79 (95% confidence interval [95%CI], 0.61-1.03; adjusted for patient age, disease stage, type of hospital, and chemotherapy); when patients age 75 years and older were excluded, the hazards ratio fell to 0.71 (95% CI, 0.54-0.94) in multivariate analysis.
  
  
  CONCLUSIONS
  The surgical treatment of patients with ovarian carcinoma by gynecologic oncologists occurred more often according to surgical guidelines, tumor removal more often was complete, and survival was improved.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Mirjam J A
authors.initials: MJ
authors.lastname: Engelen
authors.forename: Henrike E
authors.initials: HE
authors.lastname: Kos
authors.forename: Pax H B
authors.initials: PH
authors.lastname: Willemse
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aalders
authors.forename: Elisabeth G E
authors.initials: EG
authors.lastname: de Vries
authors.forename: Michael
authors.initials: M
authors.lastname: Schaapveld
authors.forename: Renee
authors.initials: R
authors.lastname: Otter
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006176:Gynecology / Q000592:standards*; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010348:Patient Care Team; D011361:Professional Competence; D012017:Referral and Consultation; D012044:Regression Analysis; D012189:Retrospective Studies; D013038:Specialization; D016019:Survival Analysis; D016896:Treatment Outcome