Stage I Ovarian Carcinoma: Specialty-Related Differences In Survival and Management

Will Patients Benefit from Regionalization of Gynecologic Cancer Care?

“…Several studies have found that treatment at specialized hospitals including high-volume centers with gynecologic oncologists as providers, are more likely to include staging procedures, lymph node biopsy, “optimal” debulking and chemotherapy according to guidelines compared to non-specialized hospitals [2], [3], [4], [5], [6], [8], [9], [13]. Many of these studies were limited by the use of Medicare-linked Surveillance, Epidemiology, and End Results (SEER) data, which includes only patients older than 65 years, a variable we have demonstrated is an independent predictor of worse survival outcomes.…”

“…To date, studies on the relationship between survival and hospital volume and teaching status for gynecologic malignancies have focused primarily on ovarian cancer [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. A systematic review of the effect of specialized care for ovarian cancer patients found no demonstrable benefit by surgeon specialty for earlier stages of disease, but that surgery by a gynecologic oncologist resulted in a 5 to 8 month median survival benefit for patients with advanced stage disease [9], [11].…”

Effect of subspecialty training on outcome after pediatric appendectomy

“…In pediatric surgery [3,[14][15][16], vascular surgery [17,18], and various types of cancer surgery [19][20][21][22][23], it has been shown that outcomes are improved when patients are cared for by surgeons with subspecialty training. However, most of these studies have been retrospective and have included only a small number of patients.…”

Diagnosis and Staging of Ovarian Cancer: Comparative Values of Doppler and Conventional US, CT, and MR Imaging Correlated with Surgery and Histopathologic Analysis—Report of the Radiology Diagnostic Oncology Group

“…In most centers, the greater the suspicion of abdominal spread, the more likely it is that a specialist in gynecologic oncology will perform the exploration. This point is important because surgery by specialists leads to better staging and maximal debulking (cytoreduction) and to longer survival (45)(46)(47)(48). Although one could argue that it is always better to overstage so that malignancy is not overlooked, it is more important to accurately distinguish malignancy that has spread into the abdomen (stage III or IV) from malignancy confined to the pelvis (stage I or II).…”