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Cancer Resources > Cancer News > 2003 > September

Surgery at teaching hospital may improve survival for advanced ovarian cancer

Last Updated: 2003-09-04 11:58:51 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In a study of ovarian cancer patients in Norway, survival for those with stage III/IV disease was improved if the primary surgery was performed at a teaching hospital rather than at a referral hospital, new research indicates.

For patients with less advanced disease the type of center did not influence survival.

Previous reports have shown a direct link between the amount of cytoreduction and median survival in ovarian cancer patients, mote the authors of the report in the September issue of Obstetrics and Gynecology. Moreover, it has been shown that gynecologist-oncologists are more likely to achieve optimal cytoreduction than general gynecologists.

In light of these findings, it is possible that survival is improved at teaching hospitals, where specialist gynecologists typically work, compared with referral hospitals, where general gynecologists are usually found.

To investigate, Dr. Solveig Tingulstad, from Trondheim University Hospital in Norway, and colleagues compared the outcomes of 38 ovarian cancer patients who underwent primary resection at a teaching hospital with those of 76 matched patients who were treated at a non-teaching hospital.

Patients with stage I/II disease fared no better or worse when treated at teaching hospitals versus referral hospitals, the authors found.

In contrast, for patients with advanced disease, surgery at a teaching hospital was associated with a 5-year survival rate of 26%, significantly higher than the 4% rate seen with resection at a referral hospital (p = 0.01).

On multivariate analysis, the completeness of chemotherapy and the size of residual tumor after surgery were identified as independent predictors of survival, the researchers note. Patients who were operated on at a teaching hospital and were left with less than 1 cm of residual disease (optimal cytoreduction) had significantly better survival than all other patient groups, independent of chemotherapy.

"Our data suggest that patients with apparent advanced ovarian cancer should be referred to a subspecialty unit, and every effort should be made to obtain as complete cytoreduction as possible during primary surgery," the investigators state.

Referral to a gynecologic-oncology subspecialty unit "may also have positively influenced the quality of life for patients with advanced disease," they add.

Obstet Gynecol 2003;102:499-505.

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