European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery

Abstract

ObjectivesThe surgical management of advanced ovarian cancer involves complex surgery. Implementation of a quality management program has a major impact on survival. The goal of this work was to develop a list of quality indicators (QIs) for advanced ovarian cancer surgery that can be used to audit and improve the clinical practice. This task has been carried out under the auspices of the European Society of Gynaecologic Oncology (ESGO).MethodsQuality indicators were based on scientific evidence and/or expert consensus. A 4-step evaluation process included a systematic literature search for the identification of potential QIs and the documentation of scientific evidence, physical meetings of an ad hoc multidisciplinarity International Development Group, an internal validation of the targets and scoring system, and an external review process involving physicians and patients.ResultsTen structural, process, or outcome indicators were selected. Quality indicators 1 to 3 are related to achievement of complete cytoreduction, caseload in the center, training, and experience of the surgeon. Quality indicators 4 to 6 are related to the overall management, including active participation to clinical research, decision-making process within a structured multidisciplinary team, and preoperative workup. Quality indicator 7 addresses the high value of adequate perioperative management. Quality indicators 8 to 10 highlight the need of recording pertinent information relevant to improvement of quality. An ESGO-approved template for the operative report has been designed. Quality indicators were described using a structured format specifying what the indicator is measuring, measurability specifications, and targets. Each QI was associated with a score, and an assessment form was built.ConclusionsThe ESGO quality criteria can be used for self-assessment, for institutional or governmental quality assurance programs, and for the certification of centers. Quality indicators and corresponding targets give practitioners and health administrators a quantitative basis for improving care and organizational processes in the surgical management of advanced ovarian cancer.

ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease

“…The selection of patients for primary debulking surgery or neoadjuvant treatment must be carried out in a specialist ovarian cancer centre, according to the ESGO Quality recommendations 2016191 in a multidisciplinary setting.…”

“…It is important to note that platinum TFI and the AGO score have only been developed as positive predictors of complete resection and cannot be used to exclude patients from surgery. Additionally, centres offering secondary cytoreductive surgery should have the necessary resources and infrastructures, including an established multidisciplinary team coordinating the pre-, intra- and post-operative care needed to achieve complete resection in the majority of these procedures 191. In second or later recurrence there is limited evidence that highly selected patients (based on PS, tumour biology and localisation of metastasis) may benefit from complete cytoreductive surgery in specialised centres 268 269…”

European Surgical Education and Training in Gynecologic Oncology: The impact of an Accredited Fellowship

“…The ESGO has also identified centers of excellence, which may serve in the future for visiting programs and exchanges. 16 In conclusion, this survey provides a broad picture of surgical training among ESGO members, revealing there is much room for improvement.…”

Barriers to Primary Debulking Surgery for Advanced Ovarian Cancer in Latin America

“…23 The European Society of Gynecology Oncology document aims to ''facilitate quality of care by comparison of performance between centers and by the establishment of organizational priorities as the basis for accreditation of centers.'' Some of the quality indicators include the rate of complete surgical resections (with an optimal rate of 965%), number of cytoreductive surgeries performed per center (optimal target 9100/year) and per surgeon (optimal target 910/year), minimum requirements in operative reports (including size and location of disease at the start and at the end of surgery and reasons for not achieving complete cytoreduction), and the use of multidisciplinary teams to plan treatment of OC.…”