Ovarian Cancer Debulking Surgery: A Survey of Practice in Australia and New Zealand

Abstract

Introduction:The purpose of our study was to survey all practicing gynecological oncologists in Australia and New Zealand to determine their definition of optimal debulking, their current surgical techniques used to achieve optimal debulking, and their reasons for using or not using such techniques.Methods:In October 2007, an email survey was distributed to all 42 practicing gynecological oncologists in Australia and New Zealand. Information obtained included practice patterns, as well as surgical expertise, techniques, and rationale with respect to primary debulking surgery for advanced epithelial ovarian cancer.Results:There was an 81% response rate. Fifty-eight percent of respondents considered optimal debulking to be residual disease less than 10 mm, 21% considered it to be less than 5 mm, and 18% considered it to be no visible disease. Sixty-five percent were able to achieve optimal debulking in their patients, as measured by their own criteria. Patient factors considered to be most frequent barriers to optimal debulking were medical comorbidities (91%) and older patient population (59%). Disease findings which most often precluded optimal debulking were disease involving the base of the mesentery (94%), confluent diaphragmatic disease (74%), and large volume, confluent peritoneal disease (50%). A variety of procedures were used by either gynecological oncologists or their colleagues, but more than 50% would never perform resection of diaphragmatic disease, resection of parenchymal liver metastases, or ablation with cavitron ultrasonic surgical aspirator or argon beam. The most common reasons for not performing ultraradical procedures were concerns regarding benefit (39%), concerns regarding morbidity (24%), and lack of personal expertise (24%).Conclusions:Most gynecological oncologists use a variety of surgical techniques to achieve optimal debulking. However, patient factors as well as concerns regarding benefit and lack of expertise were reasons cited for not performing ultraradical surgery.