Arguments for centralization of surgical treatment of ovarian cancer in France based on morbidity and mortality data

Objective > To examine the current state for ovarian cancer surgery in France from 2009 to 2016 and to examine the impact of the volume of activity on morbidity and mortality by institution. Material and method > National retrospective study analyzing surgical sessions for ovarian cancer from the program of medicalization of information systems (PMSI), from January 2009 to December 2016. Institutions were divided according to the number of annual curative procedures into 3 groups: A < 10; B: 10-19; C >= 20. A propensity score (PS) and the Kaplan -Meier method were employed for statistical analyses. Results > In total, 27,105 patients were included. The 1 -month mortality rate in group A, B and C was 1.6; 1 and 0.7 %, respectively (P < 0.001). Compared to group C, the Relative Risk (RR) of death within the first month was 2.22 for group A and 1.32 for group B (P < 0.01). After MS, the 3 - and 5 -year survival in group A + B and group C were 71.4 and 60.3% (P < 0.05) and 56.6, and 60.3% (P < 0.05), respectively. The 1 -year recurrence rate was significantly lower in group C (P < 0.0001). Conclusion > An annual volume of activity > 20 advanced stage ovarian cancers is associated with a decrease in morbidity, mortality, recurrence rate and improved survival.