The influence of the operating surgeon's specialisation on patient survival in ovarian carcinoma.

A retrospective analysis of ovarian cancer patients registered with the West Midlands Cancer Registry from 1 January 1985 to 31 December 1987 was undertaken to examine the variables associated with survival patterns, with particular reference to the specialty of the surgeon. A total of 1,654 patients were registered, of whom 1,184 had histologically confirmed ovarian cancer, with the operator identified. This consisted of 870 patients operated on by gynaecologists and 314 operated on by general surgeons. A significantly older population and a greater number of patients with stage III/IV disease were operated on by general surgeons. The median survival of patients under the general surgeons'' care was 9.87 months, significantly lower (P < 0.0001) than the survival of the gynaecologists'' patients (median survival = 29.1 months). Univariate and multivariate analysis correlated poor prognosis with advanced stage disease, older age, the presence of bulky residual tumour and a general surgeon as the operator. Stepwise Cox''s proportional hazard analysis confirmed the general surgeon as an independent adverse prognostic factor with a relative hazard ratio of 1.34 (95% confidence interval = 1.05-1.71). Accepting the limitations of retrospective reviews, these findings suggest that every attempt be made to ensure that a gynaecologist is involved in the treatment of patients with ovarian pathology.