title: Ten years' experience with centralized surgery of ovarian cancer in one health region in Norway.
abstract: BACKGROUND
  Better outcome of advanced ovarian cancer after centralized surgery has led to the recommendation for centralized surgery in a Norwegian health region. Whether the practice pattern has changed according to this recommendation has not been examined.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the referral practice and treatment of ovarian cancer in a Norwegian health region after the introduction of centralized surgery.
  
  
  METHODS
  This was a retrospective, population-based study, including all women undergoing surgery for primary ovarian, tubal, and peritoneal cancer between 2000 and 2005, in Health Region IV of Norway. Clinical data and data regarding treatment and 5-year follow-up were analyzed.
  
  
  RESULTS
  In total, 279 cases of ovarian, peritoneal, and tubal cancer were included. Eighty-four percent underwent primary surgery at the teaching hospital and 16% at the nonteaching hospitals. After an immediate rise in the number of cases undergoing primary surgery at the teaching hospital after the introduction of centralization in 1995, the percentage distribution between the teaching and nonteaching hospitals was stable during the study period. The women who underwent surgery at the nonteaching hospitals had a higher percentage of early-stage disease and were at higher risk of reoperation for comprehensive staging.
  
  
  CONCLUSIONS
  Centralization of ovarian cancer surgery has been successfully accomplished in a health region in Norway. The referral practice of assumed advanced ovarian cancer cases shows satisfactory compliance with centralization at 10 years after the implementation of centralized surgery.
authors.affiliation: Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Norway. guro.aune@ntnu.no
authors.forename: Guro
authors.initials: G
authors.lastname: Aune
authors.forename: Sverre H
authors.initials: SH
authors.lastname: Torp
authors.forename: Unni
authors.initials: U
authors.lastname: Syversen
authors.forename: Bjørn
authors.initials: B
authors.lastname: Hagen
authors.forename: Solveig
authors.initials: S
authors.lastname: Tingulstad
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000601:surgery; D019033:Delivery of Health Care, Integrated; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009664:Norway; D017063:Outcome Assessment, Health Care; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012189:Retrospective Studies; D016019:Survival Analysis; D016387:Women's Health