title: Primary surgical cytoreduction in advanced ovarian cancer: An outcome analysis within the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) Group.
abstract: OBJECTIVE
  To draw a reliable picture of the surgical management of advanced ovarian cancer (AOC) within the MITO Group, trying to correlate the disease extent at presentation, the category of center, and surgical outcome.
  
  
  METHODS
  Three tertiary referral centers for gynecologic oncology and four non-oncologic referral gynecologic surgical centers, participated in the project. A questionnaire was adopted to register perioperative data on AOCs (FIGO Stage IIICIV) consecutively operated on for a period of 12months.
  
  
  RESULTS
  A total of 205 patients were registered into the study: 140 and 65 were recruited in oncological referral centers and non-referral centers, respectively. Following a multivariate analysis, the Eisenkop score and the category of center resulted the most potent predictors of complete surgical cytoreduction followed by PCI, preoperative CA125, and ASA score. Complete surgical cytoreduction was associated with oncological referral centers (60% vs 24.6%, p<0.001). The proportion of patients undergoing additional surgical procedures was significantly different comparing the two categories of centers (at least one additional procedure was performed in 81.4% vs 50.8% in oncological referral centers compared to the others, p<0.001). Despite the more aggressive surgery performed in oncological referral centers, the perioperative outcome measures were not significantly different in the two groups.
  
  
  CONCLUSIONS
  The chance of obtaining a complete cytoreduction mainly depends on patient characteristics, tumor spread, and quality of treatment. The latter is amenable for direct influence, and therefore, seems to be of utmost importance when considering efforts aiming at improvement in the outcome of this disease.
authors.affiliation: Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy. Electronic address: s.greggi@istitutotumori.na.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Greggi
authors.affiliation: Department of Woman, Child, and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Falcone
authors.affiliation: Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Carputo
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
authors.affiliation: Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy.
authors.forename: Cono
authors.initials: C
authors.lastname: Scaffa
authors.affiliation: Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Laurelli
authors.affiliation: Department of Gynecological Oncology, Centro di Riferimento Oncologico (CRO) National Cancer Institute, Aviano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Department of Obstetrics and Gynecology, Umberto I Hospital, Bari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Vagno
authors.affiliation: Obstetrics and Gynaecology Department, IRCCS "Casa Sollievo della Sofferenza", Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Petruzzelli
authors.affiliation: Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cormio
authors.affiliation: Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marinaccio
authors.affiliation: Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Pignata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D065426:Cytoreduction Surgical Procedures / Q000592:standards*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D019538:Health Care Surveys; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008875:Middle Aged; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome