Discussion with Professor Xavier Carcopino, head of the obstetric gynecology department at the North Hospital
The management of ovarian cancer will be responsible for this year a major reform at the national level, intended to ensure patients the best possible care. They will indeed be systematically oriented towards approved centers, whose material and human resources make it possible to offer an optimal route.
Scientific literature shows that the prognosis of these patients is correlated with the volume of activity of the center where they are welcomed. In other words, a center that operates few ovary cancers has generally less good results than a center accustomed to this type of care. ARS PACA was the first in France to stimulate this change of organization by designating in the region the 3 centers capable of offering patients the most chances of healing. Public assistance – Marseille hospitals will occupy a preponderant place in the system with two approved centers: the gynecological surgery service of the North Hospital and that of the design hospital. From September 2025, all patients with ovary cancer will therefore have to be sent either to the AP-HM in one of these two competent services (north and design), or to the Paoli Calmettes Institute.
“This new operation really changes the situation for patients. Ovary cancer is a relatively rare but serious pathology, with a mortality of around 3000 deaths for 5000 cases each year. There is no screening test for ovarian cancer and very often the disease will be diagnosed in stage 3, which is already very advanced. Its management requires not only competent multidisciplinary teams, but also complete technical platforms. It is the great strength of the AP-HM services which offers, on its two northern and design sites, all the technical platforms and medical specialties necessary for optimal management of these patients. »»
Surgical management is indeed heavy and complex with interventions that can last 4 to 7 hours. The disease evolves first without notable clinical manifestation and the appearance of the first symptoms, most often abdominal swelling and stomach aches, it has already progressed significantly.
“The tumor that develops on the surface of the ovary will quickly disseminate in the belly and generate tumor nodules on the sheet which covers the abdominal cavity, namely the peritoneum. It is common that there are then multiple locations with carcinosis nodules that can partially invade the digestive tract, metastases, lymph node damage. The prognosis is then intimately linked to the ability to carry out complete surgery which will allow to remove the whole tumor and therefore leave no tumor nodule. »»
Only experienced surgeons will be able to practice these different types of interventions: hysterectomy, bilateral annexectomy, pelvic and aortic lombo tars, omentectomy (ablation of the great epiploon), appendixctomy and very often associated gestures such as colonic resections, hail, diaphragmatic dome or Selfe.
“All this requires: a technical platform allowing us to collaborate with our colleagues digestive surgeons, monitoring in resuscitation on the first post-operative days, anesthesians accustomed to this type of care, radiology and possibly interventional radiology, medical oncology. The reason why the AP-HM was chosen is that of course our two expert gynecological surgery centers, north and design, have all these resources and skills and have the highest level of safety. »»
In order to anticipate this reorganization of care, the teams have provided considerable work upstream alongside the ARS. An care charter for other centers in the region has been drawn up, detailing very precise diagnostic criteria so that cancers are detected as soon as possible and patients are as quickly as possible addressed to the AP-HM. A regional multidisciplinary consultation meeting (RCP) was also instituted via the Rofim medical collaboration platform. It brings together all the regional ovarian cancer experts, who can thus collegly decide on the most relevant care for each of the cases presented, according to the highest quality standards.
Several European countries have already adopted this operation. It is based on solid scientific data that shows that the chances of survival depend significantly on the place of care. It is thus crucial that the indications are well placed from the start.
“The possibility of complete resection surgery is determined by diagnostic laparoscopy which can be practiced by unreal centers. Ideally, this resection surgery must be carried out from the start. If it is not possible, patients will follow chemotherapy in first intention, in the hope of reducing the tumor volume to be able to operate them secondly. Hence the importance of our regional RCP where all cases of ovary cancer, without exception, are presented and analyzed for optimal therapeutic decision -making. »»
If the majority of ovarian cancers declare themselves in menopausal women, they sometimes strike young women. Another major asset of the AP-HM is to have, at the design hospital, a reproductive biology laboratory with an Onco-Fertility platform.
“If surgery remains the basis of the management of ovarian cancer, it is finally necessary to highlight the real progress made in recent years in terms of drug treatments and in particular targeted therapies, which give hope to patients. Through our scientific publications and the inclusion of patients in national therapeutic trials, we are actively participating in research. »»
Referent surgeons:
Dr Antoine Netter, Dr Laurence Piechon and Pr Xavier Carcopino (North Hospital)
Dr. Laura SABIANI, Pr Aubert
