2020 European Society of Gynaecological Oncology (ESGO) advanced ovarian cancer surgical quality indicators updated

In 2016, the European Society of Gynaecological Oncology (ESGO) developed a series of quality indicators (QIs) for advanced ovarian cancer surgery to help and review clinical practice.
QIs are internal validation criteria based on evidence-based research, multidisciplinary international development team meetings, goals and scoring systems, and involve an external review process for doctors and patients.
plan is to use QIs for self-assessment, quality assurance, and center certification.
recently, ESGO made some revisions a few years after implementing the original definition of QIs into clinical practice and central certification.
is to emphasize and focus on surgical scores.
these revisions were defined and proposed at an interdisciplinary group meeting to address the clinical significance of QIs and to assess that the actual definition and specification of evidence for QIs remains the same after the initial scoring system is implemented, as described in detail earlier.
addition, the total score of 40 points (truncation value of 32 points) remains unchanged.
the process of defining and modifying are summarized below.
based on a multidisciplinary committee meeting, a four-step evaluation process was used to develop QIs for advanced ovarian cancer surgery.
The process is based on the following values: (1) multidisciplinary international expert panels, (2) evidence-based medicine and expert consensus, (3) patient participation, (4) external review processes, (5) the proposed structured format of QIs, and (6) the rigorous assessment of conflicts of interest.
development process is outlined in Table 1.
1 Development Process: The four-step assessment process (undressed, performed in 2016) evaluates the development process framework and nominates multidisciplinary IDG members.
to identify potential QIs (n-15).
to identify scientific evidence.
IDG member independently evaluates the relevance and feasibility evaluation of each QI and discusses each potential QI (first meeting).
has retained 10 QIs.
a synthesis of scientific evidence.
evaluation of the relevance and feasibility of retained QIs (international review) by external international physicians and patient teams.
and integrate the views of international auditors (second meeting) with IDG members.
design a scoring system.
internal validation of the evaluation system.
completed a self-assessment form with the members of the Working Group.
revised the definitions and objectives of standards not universally met by the Centre of Experts (third meeting).
IDG, Interdisciplinary Group; QI, Quality Indicators.
each QIs is classified as a structural, process, or outcome indicator.
table 2 provides an overview of the evaluation criteria for these indicators.
time range for the evaluation criteria is set to the year before.
addition to the actual measurement of the indicator, the indicator also indicates the level of quality requirements that each centre should achieve.
are based on existing scientific evidence, the personal experience of team members, expert consensus, and feedback from external reviewers.
1-3 relates to the number of cases in the Centre, the training, skills and experience of surgeons and surgical teams.
quality indicators 4 - 6 are associated with the overall treatment of patients with advanced ovarian cancer.
Quality Indicator 7 emphasizes the value of adequate anesthesia and perioperative care to ensure optimal surgical results, focusing not only on reducing the incidence of surgical complications, but also on optimizing facilities and personnel to properly manage complications.
8-10 emphasizes the need for complete and transparent information exchange on patient management and surgical outcomes, including information documentation, communication with consultants and colleagues, quality assessment and improved monitoring.
Table 2 Quality Indicator QI 1: Surgical Complete Excision Rate Type Results Indicator Describes Complete Tumor Cell Reduction as far as possible under the premise of feasibility, after careful exploration of the abdominal cavity, no lesions are left visible to the naked eye.
is the first tumor cell reduction surgery, can also be a new auxiliary chemotherapy after intermittent tumor cell annihilation.
, to ensure the quality of surgery at the same time to take into account the reasonable incidence of complications, so that patients benefit most from tumor cell reduction surgery.
Consomic 1. Total excision rate (all patients): - Molecules: Number of full surgical excisions in patients with advanced ovarian cancer - denominator: All patients in the advanced ovarian cancer group 2. Proportion of patients in stage III-IV of preoperative surgery:-Molecules: Stage III-IV patients receiving initial tumor cell annihilation - denominator: target of all patients with untreated advanced ovarian cancer in the group (age) 1. Surgical complete excision rate (all patients): - Best target: 65% - Minimum requirement: 50%3. First tumor cell reduction rate (III-IV patients): - 50% scoring rule 1.8 If the best target is met, 3 if the minimum target is met goal 2.3 If goal QI 2 is achieved: The structural indicator of the number of tumor cell reduction operations per center and per surgeon per year (number of initial or intermittent tumor cell reduction operations performed per center) process indicator (number of operations per surgeon per year) describes that only surgery with the ideal tumor cell reduction as the initial goal is recorded.
includes at least two-sided fallopian ovary excision (if applicable), hysterectomy (if applicable), and comprehensive phased surgery, including retinal excision.
does not include explorative laparoscopic surgery, caesarean section, or operations that are limited to tissue biopsies.
normal molecules: 1. Number of tumor cell reduction operations per center per year 2.The number of tumor cell reduction operations performed by each surgeon each year.
can include re-tumor cell annihilation and three tumor cell annihilations.
denominator: Not applicable Target 1. Number of operations performed per center per year:- Best target: n≥100 - Intermediate target: n≥50 - Minimum requirement Target: n≥202. ≥95% of operations performed by at least 20 patients per year have surgeons to implement or monitor scoring rules 1. 7 If the best target is achieved, 4 if the intermediate target is met, 1 if the minimum target goal 2. 5 if goal QI 3 is achieved: the type of surgery performed by a gynaecologist or surgeon specializing in gynaecological oncology describes the operation performed by a certified gynaecological oncologist, or in an unorthologically certified country, by a specially trained, well-trained gynaecological cancer treatment surgeon (more than 50% of his or her practice) or an ESGO-certified physician.
Must have the skills to successfully complete abdominal and pelvic surgery to achieve the ideal tumor cell reduction specification molecule: number of patients with advanced ovarian cancer operated by a specialist (defined above): target for all patients with advanced ovarian cancer undergoing surgery≥ 90% scoring rule 3 If goal QI 4: Central type structural indicators for participation in clinical trials of gynaecological oncology describe the center active gynaecological oncology clinical trial specification molecules: not applicable to the target Non-applicable scoring rule III is active in clinical trials of gynaecological oncology QI 5: the decision to review treatment option type process indicators at a multidisciplinary treatment team (MDT) meeting describes any major treatment intervention made by a multidisciplinary team that includes at least one previously defined surgical specialist (QI2 and QI3), radiologist, pathologist (if biopsy is available) and doctor qualified for chemotherapy (in countries with specialty/ Or medical oncologists with a particular interest in gynaecological oncology) normative molecules: the denominator of the number of patients with advanced ovarian cancer who are treated with intervention by a multidisciplinary team: Target of all patients with advanced ovarian cancer who receive treatment intervention≥95% Score Rule 3 If the target is achieved QI 6: Necessary preoperative examination type process indicators describe imaging examinations that exclude substantive metastasis that cannot be removed.
has eliminated ovarian and peritocidal malignancies, such as serum CA125 and CEA levels, and/or biopsies directed by radiology or laparoscopy, by appropriate methods.
Normative Molecules: Number of Patients with Advanced Ovarian Cancer Who Underwent Tumor Reduction Surgery and Received Minimal Preoperative Examination: Target for All Suspected Advanced Ovarian Cancer Patients Undergoing Tumor Reduction Surgery≥95% Score Rule 1 If Goal QI 7: Preoperative, Inoperative, Postoperative Treatment Type Structure Indicators Are Achieved The minimum requirements for description are: (1) an intermediate nursing facility that can use the center's intensive care unit; (2) an active peri-surgical management plan specification molecule has been established: Non-applicable denominator: Non-applicable target does not apply to scoring rule 1 If the minimum requirement QI 8: Minimum element type process indicator for surgical records is met describes surgical records as structured.
must describe the size and location of the lesions at the beginning of the operation.
must describe all areas of the abdominal cavity†.
if applicable, the size and location of residual lesions at the end of the operation must be reported, as well as the reasons for incomplete tumor cell loss.
Normative Molecules: The number of patients with advanced ovarian cancer who undergo tumor cell reduction has a complete surgical record that contains all the necessary element denominatores previously defined: 90% scoring rule 90% of the target for all patients with advanced ovarian cancer who undergo tumor cell annihilation 3 If the target QI 9: The minimum element type process indicator required in the pathology report describes the disease Theology report contains all the necessary elements to regulate molecules listed in the ICCR Histopathology ReportIng Guidelines: Number of patients with advanced ovarian cancer who undergo tumor cell reduction, complete pathological reports and all essential element denominatores as defined in the ICR Histopathology Reporting Guidelines: Target for all patients with advanced ovarian cancer who undergo tumor cell reduction. 90%.
Errors in this target range reflect the inability to report on all data set components due to poor sample quality Rule 1 If Goal QI 10: Structured forward-looking report type outcome indicators for postoperative complications are met, the data to be recorded includes re-surgery, interventional radiology, re-hospitalization, referral to intermediate or intensive care units, and death.
Normative Molecules: Number of Postoperative Complications or Deaths in Patients with Advanced Ovarian Cancer Receiving Tumor Cell Reduction: Best Target for All Complications in Patients With Advanced Ovarian Cancer Receiving Tumor Cell Reduction: Minimum Requirements for Forward-Looking Records of 100% Complications: Discussion of Selected Case Score Rules 3 at Morbidity and Mortality Meetings Details of preoperative hemoglobin optimization and anemia ( non-exhaustive ) preoperative hemoglobin if optimal targets are met , liquid management involves target-oriented therapy ( GDT ) policies , rather than conventional fluid therapies without hemodynamic goals .
, the advantages of GDT over limiting fluid therapy are unclear.
There are no accepted standard monitoring methods; pain management, including no contraindications; use of epidural analgesia to avoid opioids; and systematic prevention of postoperative nausea and vomiting, although conventional medications are no longer recommended.
† Ovaries, fallopian tubes, uterus, pelvic peritina, colon side groin, front wall peritina, intestinal membrane, colon and intestinal peritina surface, liver, spleen, large or small retina, liver door, stomach, pelvic and aorta side lymph nodes and pleary cavity (if applicable).
https://mcCluggageWG, MJ, ClarkeBA, etc.
data set for reporting ovarian, fallopian tubes and primary peritometrial cancer: recommendations from the International Cancer Reporting Partnership (ICCR).
Mod Pathol 2015；28：1101-22。
CEA, cancer embryo antigen; ESGO, European Society of Gynaecological Oncology; ICCR, International Cancer Reporting Collaboration; QI, Quality Indicators.
each QI is associated with a score to form an evaluation form (Table 3).
the form is intended to support an institution's self-assessment or external assessment.
score of 40, and institutions with a score of 80% (32) can provide satisfactory surgical treatment for patients with advanced ovarian cancer.
summary: Update changes - Scoring criteria 3, 4, 8 and 10 remain unchanged.
to modify other criteria to support pure surgery programs: the score is reduced to 2.
reduced the ratings for standards 6, 7 and 9 to 1, respectively.
The seven points available after the implementation of the score reduction are as follows: - Standard 1.1: If the best target is achieved, the score will be raised to 8 points (-3) (full tumor cell reduction rate exceeds 65%) - Standard 2.1: If the optimal target (≥ 100 operations per center per year) are achieved ), the score will be increased to 7 (-2); if the intermediate target (50-99 operations per year per year) is achieved, the score will be increased to 4 (-1) - Standard 2.2: The target is revised as follows: "95% of operations are performed by surgeons who operate at least 20 operations per year" with a score of 5 (-2).
3 Update The quality index target of the self-assessment scale of the scoring system (check it if applicable) Score point 1.1 surgical complete excision rate . . . 65%8 (-3) 51%-65% 3≤50%01.2 Initial tumor cell reduction surgery rate≥50% 3 slt;50% 02.1 Number of tumor cell reduction surgery performed per center per year ≥ 1007 (-2)50-994 (-1)20-4912.2 by at least 20 operations per year under the guidance of the surgeon or performed≥ 95% 5 (-2) slt;95%03 Surgery performed by a gynecological oncologist or surgeon specializing in gynaecological oncology ≥90%3 -lt;90%0 4The center of clinical trials involved in gynaecological oncology Yes3No05 at the Multidisciplinary Treatment Team (MDT) meeting to develop and review treatment options ≥90%2 (-1)-lt;95%06 preoperative examination≥95%1 (-2)-lt;95%07 Minimum element required in preoperative, inoperative, postoperative treatment Yes1 (-2) No08 surgical records≥ 95%3 slt;90% 09 pathology report required minimum element≥90% 1 (-2) slt;90%010. Structured prospective reports of postoperative complications All complications have forward-looking records3 there is currently no database of forward-looking complications,1 but the selected diseases were discussed at the Morbidity and Mortality Conference