Surgical management of epithelial ovarian cancer at community hospitals: A population-based study.
BACKGROUND AND OBJECTIVES: Accurate surgical staging and maximal tumor reduction are the basic management principles of epithelial ovarian cancer (EOC). The purpose of our study is to report on staging practices and the primary surgery of EOC in a region that has no tertiary oncological referral center and no surgical gynecological oncologist. METHODS: Between 1 January 1989 and 30 December 1995, the Valais Cancer Registry had registered 157 patients with ovarian cancer stage I-IV. Hospital case notes were reviewed retrospectively and patients who did not have a surgical abdominal exploration (n = 20), with borderline (n = 12) or non-epithelial 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 node samplings have been performed. In advanced EOC, 40% of patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy and 42% had cytoreductive surgery with a residual tumor of </=2 cm. CONCLUSIONS: The present study is a population-based study over a 7-year period 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.