THE INFLUENCE OF THE OPERATING SURGEONS SPECIALIZATION ON PATIENT SURVIVAL IN OVARIAN-CARCINOMA

A retrospective analysis of ovarian cancer patients registered with th e West Midlands Cancer Registry from 1 January 1985 to 31 December 198 7 was undertaken to examine the variables associated with survival pat terns, with particular reference to the specialty of the surgeon. A to tal of 1,654 patients were registered, of whom 1,184 had histologicall y confirmed ovarian cancer, with the operator identified. This consist ed of 870 patients operated on by gynaecologists and 314 operated on b y general surgeons. A significantly older population and a greater num ber of patients with stage III/IV disease were operated on by general surgeons. The median survival of patients under the general surgeons' care was 9.87 months, significantly lower (P<0.0001) than the survival of the gynaecologists' patients (median survival = 29.1 months). Univ ariate and multivariate analysis correlated poor prognosis with advanc ed stage disease, older age, the presence of bulky residual tumour and a general surgeon as the operator. Stepwise Cox's proportional hazard analysis confirmed the general surgeon as an independent adverse prog nostic factor with a relative hazard ratio of 1.34 (95% confidence int erval = 1.05-1.71). Accepting the limitations of retrospective reviews , these findings suggest that every attempt be made to ensure that a g ynaecologist is involved in the treatment of patients with ovarian pat hology.