Objectives To gauge the learning curve of gynecologic oncologist (GOs) by measuring their need for intraoperative consultants in upper abdominal primary debulking surgery for advanced ovarian cancer (OC).
Methods Patients with bulky upper abdominal disease (UAB) undergoing primary debulking surgery (PDS) for OC from 1/2001–12/2013 were included. UAB was defined as tumor >1 cm cephalad to the omentum. Extensive procedures included diaphragm resection/peritonectomy, splenectomy, distal pancreatectomy, partial liver resection, resection of tumor from the porta hepatis, partial gastrectomy, and cholecystectomy.
Results Of 585 patients identified, 452 (77%) underwent UAS. The most common procedures were diaphragm resection (n=413), splenectomy (n=141), and liver resection (n=97). Over the 13-year period, the rate of patients undergoing UAS increased from 77% to 84% (p=0.019). Median number of UAS procedures was 1 (range, 1–7), remaining constant over time (p=0.129). The percentage of UAS procedures performed by consultants decreased over time, from 100% in the first quartile to 50% in the last (p<0.001). Procedures most commonly performed by consultants were cholecystectomy (89%), porta hepatis (76%) and liver resection (76%). The complete gross resection (CGR) rate increased from 18% to 46% (p<0.001). Median 3-year OS increased from 56% (95% CI, 45.9–65%) to 77% (95% CI 70.2–82%), p<0.001. OS was similar among patients who underwent UAS by a consultant versus a GO (p=0.308).
Conclusions GOs who attain the learning curve perform UAS with maximal cytoreduction, with a success rate similar to that of intraoperative consultants. Including UAS in the surgical armamentarium contributes to increased rates of CGR.
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