Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer

Acta Obstet Gynecol Scand. 2011 Oct;90(10):1126-31. doi: 10.1111/j.1600-0412.2011.01227.x. Epub 2011 Jul 27.


Objective: To prospectively estimate the agreement between a fellow in training in gynecologic oncology and a senior surgeon performing a laparoscopic score to describe peritoneal carcinosis diffusion in patients with advanced ovarian cancer.

Design: Single-institutional non-inferiority trial.

Setting: University hospital tertiary care center.

Population: Ninety consecutive patients with primary advanced ovarian cancer.

Methods: The patients underwent staging-laparoscopy by a fellow in gynecologic oncology and a senior surgeon, sequentially and blindly. Single laparoscopic parameters (omental cake, peritoneal and diaphragmatic carcinosis, mesenteric retraction, bowel stomach infiltration, superficial liver metastasis) and a comprehensive laparoscopic score (PIV) were assessed in each procedure and registered.

Main outcome measures: No differences in the score discriminating performance for predicting optimal cytoreduction were observed between fellows' and seniors' evaluations.

Results: The median number of staging laparoscopies performed by each fellow was 30 (range 28-32). The median score was 6 (0-10) for the fellows and 6 (0-14) for senior surgeons (p=ns). Results were superimposable in 57 of 90 patients (63.3%). Dividing the study period into two blocks, cases 1-45 and cases 46-90, differences were equally distributed over time (16.6 vs. 20%; p=0.9). The area under the curve of the receiver operating characteristic (ROC) curves for the score of fellows and seniors was 0.86 and 0.89, respectively (p=ns).

Conclusions: The laparoscopic assessment of peritoneal cancer diffusion according to a laparoscopic score can reliably be carried out by a fellow in gynecologic oncology after 12 months' experience without significant differences from a senior surgeon's assessment.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Competence*
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Gynecology / education
  • Hospitals, University
  • Humans
  • Internship and Residency
  • Laparoscopy / education*
  • Laparoscopy / methods
  • Learning Curve
  • Medical Staff, Hospital
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging / methods*
  • Ovarian Neoplasms / pathology*
  • Ovarian Neoplasms / surgery
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / secondary*
  • Peritoneal Neoplasms / surgery
  • Prospective Studies
  • ROC Curve
  • Risk Assessment
  • Treatment Outcome