What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer?

Objective. The purpose of this survey was to determine the range of surgica l objectives, strategies, and outcomes of primary cytoreductive operations performed by gynecologic oncologists. Methods. A survey addressing the definition of "optimal" cytoreduction, the use of neoadjuvant chemotherapy, disease sites precluding optimal cytoredu ction, reasons optimal cytoreduction or cytoreduction to a visibly disease- free outcome is or is not accomplished, the use of 15 specific operative pr ocedures, and attitude toward postfellowship training in the surgical manag ement of advanced stage epithelial ovarian cancer was mailed to candidate a nd full members of the Society of Gynecologic Oncologists. Analysis of disc rete and binomial data utilized the chi (2) and independent samples t tests . Logistic regression confirmed relationships between responses and both th e definition of optimal cytoreduction and the attitudes toward postfellowsh ip training. Results. Three hundred ninety-three (61.4%) of 640 physicians provided util izable data. A median of 95% of patients were reported to be operated on pr imarily and 5% were treated with neoadjuvant chemotherapy (P < 0.0001). A m edian of 9 (range 0-15) of the surveyed procedures were utilized. Forty-sev en (12.0%) respondents defined optimal cytoreduction as no residual disease , 54 (13.7%) used a 5-mm threshold, 239 (60.8%) used a 1-cm threshold, and 48 (12.6%) utilized a 1.5- to 2.0-cm threshold. Small dimensions of residua l disease (0-5 mm versus 1-2 em) defined optimal cytoreduction for physicia ns indicating that fewer disease sites precluded optimal cytoreduction (P = 0.02), using a larger number of the surveyed procedures (P = 0.04), and in practice longer (P = 0.001). Three hundred seventeen (83.9%) of 378 respon dents favored development of postfellowship training in cytoreductive surge ry. Physicians against postfellowship training used fewer of the surveyed p rocedures because of concerns about efficacy (P = 0.01). More recent fellow ship graduates favored postfellowship training (P = 0.01). Conclusions. A range of surgical objectives, strategies, procedures used, a nd outcomes exists among gynecologic oncologists. Confirmation of the effic acy of cytoreductive surgery may cultivate a consensus about the most appro priate therapeutic objective and strategy for advanced ovarian cancer. Coop erative efforts should be undertaken to offer postfellowship training. (C) 2001 Academic Press.