title: Surgical outcomes and national comprehensive cancer network compliance in advanced ovarian cancer surgery in a low volume military treatment facility.
abstract: OBJECTIVE
  To evaluate the optimal cytoreduction (OPT) rate, National Comprehensive Cancer Network (NCCN) treatment guideline compliance rate and patient outcomes for advanced stage epithelial ovarian cancer (EOC) patients at our low volume institution.
  
  
  METHODS
  Following IRB approval, records of patients with Stage III-IV EOC, primary peritoneal, or fallopian tube carcinoma completing both primary surgery and adjuvant chemotherapy were reviewed. Patient demographics, clinicopathologic variables, cytoreduction status (optimal or suboptimal), NCCN treatment guideline compliance, and survival were reviewed. Standard statistical tests including the t-test, Chi-square or Fisher's exact test and Kaplan-Meier Survival curves were utilized.
  
  
  RESULTS
  Overall, 48 patients met all inclusion criteria. 35(73%) and 13 (27%) achieved optimal and suboptimal cytoreduction, respectively. Median overall survival (OS) for all patients was 37.1 months (95% CI 23.2 - 51.1 months) and NCCN treatment guideline compliance was 85.4%. Compared to sub-optimally cytoreduced patients the optimally cytoreduced patients were significantly older (62.2 vs. 53.5 yrs; p=0.015); no other significant clinicopathologic differences were observed between the two groups. 19 of 48 (39.6%) patients enrolled in an upfront cooperative group trial. Median OS was 43.4 months for optimally compared to 15.6 months in sub-optimally cytoreduced patients (p=0.012).
  
  
  CONCLUSIONS
  NCCN treatment guideline compliance, OPT, and median OS rates in our low volume institution are similar to those reported nationally, and argue against using volume alone as a rationale for centralization of care.
authors.affiliation: Division of Gynecologic Oncology, Department of OB/GYN, San Antonio Military Medical Center, San Antonio, TX, USA.
authors.forename: Neil T
authors.initials: NT
authors.lastname: Phippen
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
authors.forename: William J
authors.initials: WJ
authors.lastname: Lowery
authors.forename: Caela R
authors.initials: CR
authors.lastname: Miller
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D000077216:Carcinoma, Ovarian Epithelial; D005185:Fallopian Tube Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D061846:Hospitals, Low-Volume / Q000592:standards*; D006772:Hospitals, Military / Q000592:standards*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014481:United States
keywords: Cancer care disparities; Centralization of care; Epithelial ovarian cancer; NCCN guidelines; Surgical cytoreduction