An analysis of deviation from the ESGO quality indicators for surgical treatment of cervical cancer in a large referral center in the Netherlands

Abstract

Recently, the European Society of Gynaecological Oncology (ESGO) presented fifteen quality indicators (QIs) with the aim to improve quality of surgical treatment for cervical cancer. In this study, we analyzed compliance with these QIs in a large referral center in the Netherlands. A critical analysis of the QIs that deviated from the targets was performed. Data of all 402 patients, who were surgically treated for cervical cancer with International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage IA-IIA at the Amsterdam University Medical Center from 2007-2016, were retrospectivly analyzed with regard to adherence to the ESGO QIs. Targets set for three out of 15 ESGO QIs were not met. A pre-operative Magnetic Resonance Imaging (MRI) was performed in 92% of patients (target 100%). The percentage of upstaging of clinical stage into a higher pathological stage after surgery was 17.2% (target <10%). The third target that was not met was the minimally required elements in the pathology report. Parametrial length measured in two dimensions, histological grade and extra-nodal extension of lymph node metastasis were reported in respectively 0%, 32% and 42%, whereas the target was ≥90%. In contrast to the three QI targets that were not met, performance with regard to two out of 15 QI was far better than the targets set. This included recurrence rate at 2 years and the percentage of adjuvant (chemo)radiotherapy in (p)T1b1N0. QIs are important to evaluate care. They should be clearly described to ensure they are correctly interpreted. QIs and their targets should be based on solid evidence to ensure that reaching the target results in improvement of quality of care. Although the three QI targets that were not reached in our center are subject to criticism, they are still useful for prospective data collection and quality evaluation.