The landscape of ovarian cancer surgery in Italy: Data from PNE

Abstract

Objective: Ovarian cancer (OC) in Italy is tenth in incidence among tumors in females, and it is the cause of 30 % of deaths due to gynecological tumors. The objective of this study is to evaluate the volume of patients undergoing surgical treatment for OC in Italian hospital facilities.

Methods: An analysis of hospitalization volumes due to OC in Italian medical facilities in 2022 based on the Piano Nazionale Esiti was performed. Centers were divided into 3 categories, according to the annual number of hospitalizations due to OC (above 30, between 20 and 29, below 20); the percentage of patients treated in each category of hospitals was calculated. Additionally, an evaluation of the active mobility (meaning the number of patients living outside the region but receiving treatment in the region taken into examination) and passive mobility (meaning the number of patients living inside the examined region but choosing to receive treatment in centers located outside of the region itself) was carried out for each region.

Results: The study showed that, in 11 Italian regions, most of OC cases are treated in medical centers with patient volumes of less than 20 cases per year. Only in 6 regions, OC cases are mostly treated in larger centers; in these same regions, the highest percentages of active mobility are recorded. Finally, in 6 Italian regions, passive mobility exceeds 50 % of regional cases.

Conclusions: Nowadays, the landscape of OC treatment in Italy is extremely heterogeneous. In most regions, patients receive treatment in low volume centers; concurrently, huge volumes of patients hailing from the entire national territory are treated in a limited number of centers.

Fig. 1

Distribution of high/intermediate/low volume hospitals for OC surgery in Italian regions

Fig. 2

The maps visually represent the disparity in ovarian cancer treatment in Italy, where some regions benefit from specialised care in Hub centers, while others rely on smaller, less specialized facilities. Darker colors represent regions with a higher percentage of cases. A: percentage of the total number of Italian OC cases for each region. Some regions have higher percentage of cases, such Lombardia and Lazio. B: percentage of OC cases treated in high-capacity "hub" centers (>30 cases/year) for each region. There is a disparity between northern regions with high hub treatment rate and southern regions with lower or none. C: percentage of OC cases treated in medium-capacity centers (20-20 cases/year). D: percentage of OC cases treated in spoke centers (< 20 cases/year).