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Review
. 2020 Nov 25;18(1):309.
doi: 10.1186/s12957-020-02064-7.

Outcome quality standards in advanced ovarian cancer surgery

Antoni Llueca  1   2   3 , Anna Serra  4   5   6 , Maria Teresa Climent  4   5   6 , Blanca Segarra  4   5 , Yasmine Maazouzi  4   5 , Marta Soriano  5   7 , Javier Escrig  5   6   8 ; on behalf MUAPOS Working Group
Collaborators, Affiliations
Review

Outcome quality standards in advanced ovarian cancer surgery

Antoni Llueca et al. World J Surg Oncol. .

Erratum in

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.

Keywords: Advanced ovarian cancer; Cytoreductive surgery; Medical care; Morbidity; Outcome; Quality indicator; Tumor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Complete cytoreductive surgery (CCS) rate (P-chart). Each dot represents an included study. The gray area (standard zone) is within the 95% confidence interval, the blue area (alert zone) is between the 95% and 99.8% confidence intervals, and the white area (alarm zone) is outside the 99.8% limit
Fig. 2
Fig. 2
Optimal cytoreductive surgery (OCS) rate (P-chart). Each dot represents an included study. The gray area (standard zone) is within the 95% confidence interval, the blue area (alert zone) is between the 95% and 99.8% confidence intervals, and the white area (alarm zone) is outside of the 99.8% limit
Fig. 3
Fig. 3
Suboptimal cytoreductive surgery (SCS) rate (P-chart). Each dot represents an included study. The gray area (standard zone) is within the 95% confidence interval, the blue area (alert zone) is between the 95% and 99.8% confidence intervals, and the white area (alarm zone) is outside of the 99.8% limit
Fig. 4
Fig. 4
Morbidity rate (P-chart). Each dot represents an included study. The gray area (standard zone) is within the 95% confidence interval, the blue area (alert zone) is between the 95% and 99.8% confidence intervals, and the white area (alarm zone) is outside of the 99.8% limit
Fig. 5
Fig. 5
Five-year survival rate (P-chart). Each dot represents an included study. The gray area (standard zone) is within the 95% confidence interval, the blue area (alert zone) is between the 95% and 99.8% confidence intervals, and the white area (alarm zone) is outside of the 99.8% limit
See this image and copyright information in PMC

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