Introduction/Background*Surgical management of advanced ovarian cancer(AOC) is considered technically challenging. In order to achieve the required outcomes a centre requires expertise and flow of cases. ESGO recommends that accredited centres perform at least 24 complete cytoreductive(CCR) surgeries per year, with a minimum of 12 complete primary debulking surgeries(PDS).
Malta is a small European island with a population of 520,000, seeing an average of 40 ovarian cancer cases per year, 20 of which are AOC. Being a small island, Malta faces a different reality and numerous challenges compared to other European countries.
Methodology This is a retrospective study, where all abnormal histology results suggestive of abnormal ovarian pathology during the time period of 2008-2016, processed by the Pathology Department in Mater Dei Hospital Malta were assessed. Furthermore, data was collected by reviewing the electronic medical records, histology results and imaging.
Result(s)*Over the 8 year period,146 new patients were diagnosed with advanced ovarian cancer. The median age at diagnosis was 64.5(33-91)years. 105/146(71.9%) women presented with FIGO stage III and 41/146(28.1%) with stage IV disease. Overall survival(OS) 32.87months with a 1-year survival of 70.55% and 5-year survival of 20.28%. Treatment was offered to 128/146(87.67%), 103(80.47%) patients were offered surgery, 72(69.9%) received PDS whilst 26(25.24%) had Interval debulking surgery(IDS). CCR was achieved in 10(9.5%) cases, whilst optimal and suboptimal cytoreduction was achieved in 95(90.5%) patients. OS in patients having surgery was 42.4 months, with a 1-year survival of 83.33% and 5-year survival of 27%. 26(20.31%) patients received chemotherapy only as a treatment option with an OS was 25.2 months, with a 1-year survival of 61.53% and 5-year survival of 7.69%. From the 16 patients who received best supportive care, 14/16(87.5%) died within 6 months following diagnosis.
Conclusion*The amount CCR achieved during debulking surgery was noted to be low. In order to achieve better results, it may be appropriate that AOC treatment strategy is revised, by either moving towards IDS, which we have seen in the latter 3 years, or by investing in improving the surgical expertise. Despite low levels of CCR, survival rates are comparable with other European centres.
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