Surgical management of epithelial ovarian cancer at community hospitals: Apopulation-based study

Background and Objectives: Accurate surgical staging and maximal tumor redu ction are the basic management principles of epithelial ovarian cancer (EOC ). The purpose of our study is to report on staging practices and the prima ry surgery of EOC in a region that has no tertiary oncological referral cen ter and no surgical gynecological oncologist. Methods: Between 1 January 1989 and 30 December 1995, the Valais Cancer Reg istry had registered 157 patients with ovarian cancer stage I-IV. Hospital case notes were reviewed retrospectively and patients who did not have a su rgical abdominal exploration (n = 20), with borderline (n = 12) or non-epit helial tumors (n = 13), operated upon in other regions (n = 8) and without complete medical records (n = 2) were excluded. Therefore 102 patients were evaluated. Results: The interventions have been performed in 7 regional hospitals and 1 private clinic by 24 obstetricians-gynecologists and 8 general surgeons. In early EOC, 9% random peritoneal biopsies and 3% retroperitoneal lymph no de samplings have been performed. In advanced EOC, 40% of patients had tota l abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy a nd 42% had cytoreductive surgery with a residual tumor of less than or equa l to 2 cm. Conclusions: The present study is a population-based study over a 7-year pe riod within a region that has only community hospitals. Patients with early EOC had incomplete staging and patients with advanced EOC an insufficient rate of radical surgery. Women with a suspicion of ovarian cancer should be referred to centers with experienced tumor surgeons. J. Surg. Oncol. 2000; 75:19-23. (C) 2000 Wiley-Liss, Inc.