Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands

Gynecol Oncol. 2009 Mar;112(3):455-61. doi: 10.1016/j.ygyno.2008.11.011. Epub 2009 Jan 12.


Objective: We investigated the influence of hospital and gynecologist level of specialization and volume on surgical results and on survival of ovarian cancer patients.

Methods: Data were collected from 1077 ovarian cancer patients treated from 1996 to 2003 in a random sample of 18 Dutch hospitals. Hospitals and gynecologists were classified according to specialization (general, semi-specialized or specialized) and by volume (<or=6, 7-12, or >12 cases/year). Outcomes were percentage of adequately staged and optimally debulked patients and length of overall survival. Data were analyzed using multivariable logistic regression (surgical results) and Cox regression (survival).

Results: The level of specialization and the volume of hospitals and of gynecologists were strongly related to the proportion of adequately staged patients (adjusted odds ratio (OR) specialized hospitals 3.9 (95% confidence interval (CI) 2.0-7.6); specialized gynecologists 9.5 (95% CI 4.7-19)). Patients with stage III disease had a higher chance of optimal debulking when treated in specialized hospitals (adjusted OR 1.7 (95% CI 1.1-2.7)) or by high volume gynecologists (adjusted OR 2.8 (95% CI 1.4-5.7)). Overall survival was best in patients treated in specialized hospitals and by high-volume gynecologists.

Conclusion: The specialization level of hospitals and the surgical volume of gynecologists positively influence outcomes of surgery and survival. Concentration of ovarian cancer care thus seems warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Gynecologic Surgical Procedures / standards
  • Gynecologic Surgical Procedures / statistics & numerical data
  • Gynecology / standards
  • Hospitals, General / statistics & numerical data*
  • Hospitals, Special / statistics & numerical data*
  • Humans
  • Logistic Models
  • Middle Aged
  • Neoplasm Staging
  • Netherlands
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery*
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome