title: [Effectiveness of "threshold" in the management of ovarian cancer: A review of the literature].
abstract: OBJECTIVE
  The "Institut national du cancer" has established since 2007 a minimum threshold of 20 patients per year per center to treat patients with gynecologic cancer. This review aims to assess whether the literature data validate this approach, and specifically for ovarian cancer.
  
  
  METHODS
  A search of the MEDLINE database was conducted, to reference all relevant articles evaluating one hand the links between the survival of patients with ovarian cancer and the average volume of patients per center and by operator; and secondly the relationship between quality of oncological surgery and these volumes.
  
  
  RESULTS
  Nineteen studies met our inclusion criteria; seventeen were retrospective and two were prospective; population samples ranged from 476 to 96,802 patients. The most important data, quantitatively and qualitatively, concern the evaluation of survival based on the average volume per center, with 8 out of 13 studies finding a statistically significant correlation between average volume per center and survival. Data on the quality of surgery are less abundant and more heterogeneous, depending on the definition of the "optimal" surgery by the authors.
  
  
  CONCLUSIONS
  The establishment of threshold centers appears to be an effective way to improve survival in ovarian cancer. However, these thresholds would have to be specific to ovarian cancer and not extended to "gynecological cancers."
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France. Electronic address: julien.seror@curie.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Seror
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: Eugénie
authors.initials: E
authors.lastname: Guillot
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Genin
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-St-Quentin-en-Yvelines, EA 7285, risques cliniques et sécurité en santé des femmes et en santé périnatale, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Hequet
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pouget
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: Coraline
authors.initials: C
authors.lastname: Dubot
authors.affiliation: Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-St-Quentin-en-Yvelines, EA 7285, risques cliniques et sécurité en santé des femmes et en santé périnatale, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
mesh_terms: D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000601:surgery; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data; D016019:Survival Analysis
keywords: Cancer de l’ovaire; Chirurgie; Ovarian cancer; Seuil; Surgery; Survie; Survival; Threshold; Volume