Betere overleving van patiënten met ovariumcarcinoom na primaire chirurgie door een gynaecologisch oncoloog dan na operatie door een algemeen gynaecoloog

Objective

To evaluate the quality of operations performed by gynaecological oncologists and by general gynaecologists, also with respect to survival rates of patients with ovarian carcinoma.

Design

Retrospective cohort study.

Method

Using a specially developed data collection form, data managers at the Dutch Comprehensive Cancer Centre (North), collected data from the hospital case-notes of all 680 patients diagnosed with ovarian carcinoma in the northern part of the Netherlands between 1994 and 1997. Data on medical history, diagnostics, operation, adjuvant therapy and follow-up were collected. The quality of the data was assessed by a gynaecological researcher. The results of treatment were analysed according to surgical specialization by means of survival curves and univariate and multivariate Cox regression analyses.

Results

In 184 patients primary surgery was performed by gynaecological oncologists, and, in 328 patients, by general gynaecologists (512 patients in total). The 184 patients treated by gynaecological oncologists were at all stages of disease and the majority (120/84) were operated on in hospitals outside the cancer centre. Gynaecological oncologists adhered more strictly to national surgical guidelines than general gynaecologists. The 5-year overall survival rate of patients operated on by oncological gynaecologists was higher than in patients operated on by general gynaecologists at both early and later stages of disease (stage III of the International Federation of Gynaecology and Obstetrics; FIGO). Multivariate analysis showed that the relative risk of death for patients operated on by gynaecological oncologists was 20% less than for patients treated by a general gynaecologist when adjusted for patient age, stage of disease, type of hospital, and adjuvant chemotherapy. When patients aged 75 years and older were excluded, this reduction was nearly 30% (hazard ratio 0.71; 95% CI: 0.54-0.94).

Conclusion

If primary surgery in patients with ovarian carcinoma is carried out by a gynaecological oncologist instead of a general gynaecologist, their survival is improved. Care for patients with ovarian carcinoma may be enhanced by involving an gynaecological oncologist at an early stage.