Current South African clinical Practice in Debulking Surgery for Ovarian Cancer.

Abstract

The aim of this study was to assess practice patterns and rationale with regard to debulking surgery for advanced epithelial ovarian carcinoma among South African Gynaecological oncologists. A survey was distributed to all practicing gynecological oncologists in South Africa. It was structured to assess definitions of optimal debulking, procedures used to achieve optimal debulking, and reasons for not performing specific procedures. Respondents were also asked to report on experience and additional surgical training to improve skill in performing ultra-radical debulking surgery. Eighty percent of gynecological oncologists completed the survey. Sixty percent of respondents reported that they view optimal debulking as no visible disease, and this was achieved in 63% of surgical cases. The most common barriers to optimal debulking were medical comorbidities (85%), followed by lack of expertise in ultra-radical debulking surgery (55%) and advanced patient age (40%). At operation, the most common disease findings precluding optimal debulking were large volume confluent peritoneal disease and confluent diaphragmatic disease. All of the surgeons perform excision of bulky pelvic and lower paraaortic nodes themselves. Bowel resections are often performed with the help of a colleague, but more than half of the respondents never perform diaphragmatic stripping, resection of liver metastases, distal pancreatic resection, or ablation of peritoneal metastases. Overall, most participants seem to regularly perform debulking procedures in the pelvis but are less comfortable with resection of upper abdominal or peritoneal disease. Most common reasons for not performing procedures were concerns about patient morbidity and concerns regarding benefit. Fifty percent of respondents also reported a lack of personal expertise in performing ultra-radical debulking procedures. The progression of South African Gynaecological Oncologist towards more aggressive debulking surgery is following international trends, but many of the surgeons report a lack of experience in ultra-radical debulking surgery, especially in the upper abdomen.