Outcome quality standards in advanced ovarian cancer surgery
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(2020) 18:309
REVIEW
Open Access
Outcome quality standards in advanced ovarian cancer surgery Antoni Llueca1,2,3* , Anna Serra1,2,3, Maria Teresa Climent1,2,3, Blanca Segarra1,2, Yasmine Maazouzi1,2, Marta Soriano2,4, Javier Escrig2,3,5 and on behalf MUAPOS Working Group2
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 5year 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. Keywords: Advanced ovarian cancer, Cytoreductive surgery, Outcome, Morbidity, Tumor, Quality indicator, Medical care
Highlights Quality indicators are described in advanced ovarian
cancer surgery(AOCS) Acceptable quality limits are defined as standards in
AOCS * Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, University General Hospital of Castellón, Av Benicasim s/n, 12004 Castellón, Spain 2 Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Av Benicasim s/n, 12004 Castellón, Spain Full list of author information is available at the end of the article
Introduction Advanced ovarian cancer surgery (AOCS) aims to achieve maximal cytoreduction to increase survival, and even provide a definitive cure in some cases. Generally, this comprises an aggressive surgery that frequently results in serious postoperative complications, including patient’s mortality or the impossibility of administration of subsequent oncological
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