The Quality of the Operative Report for Women With Ovarian Cancer in Ontario
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OBJECTIVE: To assess the quality of the operative reports from cases of ovarian cancer surgery in Ontario. METHODS: We undertook a population cohort study including all newly diagnosed ovarian cancer patients treated initially with surgery from January 1996 to December 1998 in Ontario (n = 1341). We abstracted charts from hospitals and cancer centres. All surgical and pathology notes were abstracted into an ACCESS database. RESULTS: A total of 1,341 women had surgery as the first step in management of ovarian cancer. A vertical abdominal incision was used in 87.6% of these cases. Peritoneal cytology was obtained in 87.8% of cases overall, but in only 69.5% of stage 1 cases. A description of the ovaries was provided in 85% of reports, of the uterus in 70%, the diaphragm in 53%, the liver in 69%, the pelvic lymph nodes in 10%, and the para-aortic lymph nodes in 41%. In stage 1 cases, the ovaries were assessed histologically in 89% of cases, the uterus in 80%, the omentum in 69%, the peritoneum in 20%, the appendix in 9%, the pelvic lymph nodes in 10%, and the para-aortic lymph nodes in 7%. Frozen section was obtained in half of the stage 1 cases, and the false negative rate for identifying malignancy was 6%. In all, 23% of women received adequate surgical staging for stage 1 disease, and 12% of women with advanced disease had optimal debulking (to less than 1 cm residual disease). There are clear differences between centres with a gynaecologic oncologist on staff and other centres in the adequacy of surgical staging in women with stage 1 disease (chi2 = 60.6, P < 0.0001) and in optimal debulking for advanced disease (chi2 = 39.1, P < 0.0001). In 40% of cases with advanced disease, the amount of residual disease following surgery is not reported. CONCLUSION: The current approach of dictating operative notes does not provide sufficient detail in a large number of cases; this affects treatment decisions and limits our ability to assess quality indicators for operative care in ovarian cancer. This problem is pervasive but is more significant in centres without a gynaecologic oncologist.
