title: Specialist surgery for ovarian cancer in England.
abstract: OBJECTIVE
  The aim of this study is to evaluate the impact of the 1999 national recommendations for ovarian cancer surgery in England to be performed by specialist surgeons in specialist centres.
  
  
  METHODS
  A retrospective analysis of English cancer registry records, Hospital Episode Statistics (HES) data for all English NHS providers and General Medical Council (GMC) sub-specialty accreditation, to consider changes to the annual proportion of ovarian cancer (ICD10 C56-C57) patients undergoing major gynaecological surgery in gynaecological cancer centres (GCCs) or by specialist gynaecological oncologists (GOs).
  
  
  RESULTS
  From 2000 to 2009, 2428 consultants were responsible for surgery on 30,753 patients. There were significant increases in the proportions of patients undergoing surgery at GCCs (43% to 76%, P<0.001), by GMC accredited GOs (5% to 36%, P<0.001), and by high ovarian cancer caseload (≥18 cases) surgeons (22% to 56%, P<0.001).
  
  
  CONCLUSIONS
  There have been increased centralisation and specialisation of surgery for ovarian cancer patients since the NHS Cancer Plan (2000) and there has also been improved survival. However, by 2009, many ovarian cancer patients were still not receiving specialist surgery; the majority of patients were not operated on by GMC accredited gynaecological oncologists and there was considerable regional variation. Systems of accreditation should be reviewed and trusts should ensure that HES data accurately records clinical activity.
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London SW3 6JJ, UK. Electronic address: John.Butler@cancer.org.uk.
authors.forename: John
authors.initials: J
authors.lastname: Butler
authors.affiliation: Public Health England Knowledge & Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK.
authors.forename: Carolynn
authors.initials: C
authors.lastname: Gildea
authors.affiliation: Public Health England Knowledge & Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK.
authors.forename: Jason
authors.initials: J
authors.lastname: Poole
authors.affiliation: Public Health England Knowledge & Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK.
authors.forename: David
authors.initials: D
authors.lastname: Meechan
authors.affiliation: East Kent Gynaecological Centre, East Kent Hospitals University NHS Foundation Trust, QEQM Hospital, St Peters Road, Margate, Kent, UK; Gynaecological Site Specific Clinical Reference Group (SSCGR), National Cancer Intelligence Network (NCIN), 5th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nordin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008495:Medical Oncology / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D055815:Young Adult
keywords: Gynaecological cancer centres; Gynaecological oncologist; Ovarian cancer; Specialist; Surgery