title: Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer.
abstract: OBJECTIVE
  To prospectively estimate the agreement between a fellow in training in gynecologic oncology and a senior surgeon performing a laparoscopic score to describe peritoneal carcinosis diffusion in patients with advanced ovarian cancer.
  
  
  METHODS
  Single-institutional non-inferiority trial.
  
  
  METHODS
  University hospital tertiary care center.
  
  
  METHODS
  Ninety consecutive patients with primary advanced ovarian cancer.
  
  
  METHODS
  The patients underwent staging-laparoscopy by a fellow in gynecologic oncology and a senior surgeon, sequentially and blindly. Single laparoscopic parameters (omental cake, peritoneal and diaphragmatic carcinosis, mesenteric retraction, bowel stomach infiltration, superficial liver metastasis) and a comprehensive laparoscopic score (PIV) were assessed in each procedure and registered.
  
  
  METHODS
  No differences in the score discriminating performance for predicting optimal cytoreduction were observed between fellows' and seniors' evaluations.
  
  
  RESULTS
  The median number of staging laparoscopies performed by each fellow was 30 (range 28-32). The median score was 6 (0-10) for the fellows and 6 (0-14) for senior surgeons (p=ns). Results were superimposable in 57 of 90 patients (63.3%). Dividing the study period into two blocks, cases 1-45 and cases 46-90, differences were equally distributed over time (16.6 vs. 20%; p=0.9). The area under the curve of the receiver operating characteristic (ROC) curves for the score of fellows and seniors was 0.86 and 0.89, respectively (p=ns).
  
  
  CONCLUSIONS
  The laparoscopic assessment of peritoneal cancer diffusion according to a laparoscopic score can reliably be carried out by a fellow in gynecologic oncology after 12 months' experience without significant differences from a senior surgeon's assessment.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart-Agostino Gemelli Hospital, Largo A. Gemelli 8, Rome, Italy. anna.fagotti@rm.unicatt.it
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vizzielli
authors.forename: Barbara
authors.initials: B
authors.lastname: Costantini
authors.forename: Antonella
authors.initials: A
authors.lastname: Lecca
authors.forename: Valerio
authors.initials: V
authors.lastname: Gallotta
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Gagliardi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006176:Gynecology / Q000193:education; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D016896:Treatment Outcome