Surgical program building in advanced ovarian cancer: European perspective

The majority of ovarian cancer patients are diagnosed with advanced-stage disease, for which standard treatment consists of cytoreductive surgery and platinum-based chemotherapy. As the maximum diameter of residual disease at the end of cytoreductive surgery is one of the most important prognostic factors, chances to achieve complete debulking of tumor should be optimized. Therefore, cytoreductive surgery is best performed in an expert center. To establish such an expert center, not only surgical skills and experience are needed. High quality surgical care is delivered by a multidisciplinary team of, among others, oncology nurses, anesthesiologists, pathologists, dieticians and physiotherapists. Furthermore, expert centers typically deliver comprehensive cancer care, including expertise in radiotherapy and chemotherapy, palliative care and patient support. Development and implementation of a surgical program aiming at establishing an expert center for cytoreductive surgery involves careful assessment of the pre-program pattern of care, training of care providers, establishment of a multidisciplinary team and referral pathway, availability of sufficient resources and infrastructure and a monitoring and quality assurance plan. The aim of this paper is to give guidance in programmatic development of an expert center for advanced ovarian cancer surgery from a European perspective.