Unfortunately 80% of women affected by an ovarian cancer are diagnosed at an advanced stage when the disease has already extended into the pelvic and abdominal cavity. There are several independent prognostic factors of women affected by an advanced stage ovarian cancer but the only modifiable prognostic factor is the surgical cytoreduction, that means the surgical removal of all the macroscopic disease. This means to perform several surgical procedures at the same times in the same patient including radical removal of the internal genital organs but also to perform diaphragmatic surgeries, liver surgeries, removal of the spleen, pelvic and aortic lymphadenectomy etc. etc. So the surgical procedure used to be very complex and we need to be very well prepared to perform the whole procedure. In any case we need to work in a surgical multidisciplinary team, not only does this need to be led by gynaecologic oncologists but also we need to work during with general surgeons, anesthesiologists etc. etc.

So how many women with ovarian cancer are able to have this type of surgery?

That is a problem because we have a non-centralised system of care. That means that virtually all general surgeons, obstetrics and gynaecologists or gynaecologic oncologists can operate on this type of patient, can perform this type of very complex surgical procedure instead of referring this patient to a specialist surgeon. It is very well demonstrated that gynaecologic oncologists can offer the best quality of care for women affected by an advanced stage ovarian cancer but also these gynaecologic oncologists need to work in a multidisciplinary unit in a referral hospital. In this way we need to offer the best quality of care for these affected women with advanced stage ovarian cancer. This multidisciplinary team needs to also work joined with medical oncologists, radiotherapists, radiologists, medical oncologists and psycho-oncologists etc. in order to offer the best strategy of treatment for each individual case. Unfortunately there is a recent study published in the United States demonstrating that only 4% of women affected by an advanced stage ovarian cancer receive treatment by a high volume surgeon in a high volume hospital. The vast majority of these women receive treatment by a low volume physician in a low volume hospital. It is also very well demonstrated that when surgery is performed by a gynaecologic oncologist patients live a significantly longer period of time. So we need to review the policy of doing this type of surgery and probably we need to establish in each individual country or worldwide an adequate policy of referral of these patients to a specialised institution with well trained surgeons.