Outcome quality standards in advanced ovarian cancer surgery

Abstract

Introduction Advanced ovarian cancer surgery (AOCS) frequently results in serious postoperative complications. Because managing AOCS is difficult, some standards need to be established that allow surgeons to assess the quality of treatment provided and consider what aspects should improve. This study aimed to identify quality indicators (QIs) of clinical relevance and to establish their acceptable quality limits (i.e., standard) in AOCS. Materials and methods We performed a systematic search on clinical practice guidelines, consensus conferences, and reviews on the outcome and quality of AOCS to identify which QIs have clinical relevance in AOCS. We then searched the literature (from January 2006 to December 2018) for each QI in combination with the keywords of advanced ovarian cancer, surgery, outcome, and oncology. Standards for each QI were determined by statistical process control techniques. The acceptable quality limits for each QI were defined as being within the limits of the 99.8% interval, which indicated a favorable outcome. Results A total of 38 studies were included. The QIs selected for AOCS were complete removal of the tumor upon visual inspection (complete cytoreductive surgery), a residual tumor of < 1 cm (optimal cytoreductive surgery), a residual tumor of > 1 cm (suboptimal cytoreductive surgery), major morbidity, and 5-year survival. The rates of complete cytoreductive surgery, optimal cytoreductive surgery, suboptimal cytoreductive surgery, morbidity, and 5-year survival had quality limits of < 27%, < 23%, > 39%, > 33%, and < 27%, respectively. Conclusion Our results provide a general view of clinical indicators for AOCS. Acceptable quality limits that can be considered as standards were established.

Postoperative pulmonary complications and outcomes in cytoreductive surgery for ovarian cancer: a propensity-matched analysis

“…Although perioperative management and surgical techniques are developing rapidly, postoperative complications may still be inevitable. A systematic review reported that the major complication rate was 23% for advanced ovarian cancer surgery [ 4 ]. Several findings have indicated that pleural effusion is the most common complication after cytoreduction for advanced stage epithelial ovarian cancer [ 5 , 6 ].…”

Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

“…Whether anastomosis breakdown and other postoperative complications could be related to poor nutrition status is a hypothesis that cannot be ruled out. It should be taken into account that complications after surgery are related to surgical parameters but also depend on patient factors [ 21 ]. A study of patients with colorectal cancer resection showed no significant beneficial reduction in postoperative complications following nutritional supplementation, although patients who received whey protein supplementation 4 weeks before surgery had a mean improvement in functional walking capacity [ 22 ].…”

Relationship Between Neoadjuvant Chemotherapy and Log Odds of Positive Lymph Nodes and Their Prognostic Role in Advanced Ovarian Cancer Patients With Optimal Cytoreductive Surgery

“…Complete cytoreductive surgery with platinum-based chemotherapy is the standard treatment for patients with AOC ( 7 ). The Society of Gynecologic Oncology and American Society of Clinical Oncology issued practice guidelines recommending NACT for patients with high perioperative risk or low likelihood of achieving optimal cytoreductive surgery ( 5 ). In our retrospective study, 757 AOC patients with optimal cytoreductive surgery had undergone NACT while 255 did not.…”

“…Standard of care for patients with advanced ovarian cancer (AOC) is primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy ( 5 , 6 ). The leading prognostic factor in determining survival of patients with AOC is achievement of complete cytoreductive surgery with the aim of macroscopically complete resection of all visible tumor, followed by chemotherapy that includes carboplatin and paclitaxel ( 7 ).…”