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5.3 QI 3 - Surgery performed by a gynecologic oncologist or a trained surgeon
specifically dedicated to gynaecological cancers management
5.3.1 Description of the QI
TYPE Process indicator.
DESCRIPTION Surgery is performed by a certified gynecologic oncologist or, in countries where
certification is not organized, by a trained surgeon dedicated to the management of
gynecologic cancer accounting for over 50% of his practice or having completed an
ESGO accredited fellowship. Skills to successfully complete abdominal and pelvic
surgery procedures necessary to achieve complete cytoreduction must be available.
SPECIFICATIONS Numerator: number of patients with advanced ovarian cancer operated by a specialist as
defined above.
Denominator: all patients undergoing surgery for advanced ovarian cancer.
TARGETS ≥ 90%.
SCORING RULE 3 if the target is met.
5.3.2 Rationale
In Europe, organization of gynecologic oncology differs among countries but there is a trend of centralization
and subspecialization. The ESGO, in collaboration with the European Board and College of Obstetricians and
Gynecologists, has developed a subspecialty training program in gynecologic oncology.
Three previous initiatives26,53,118 published a QI for this topic. Furthermore, the three guidelines122,123,125
identified for this topic suggest or recommend that the surgery should be performed by a gynecologic oncologist
or a trained surgeon specifically dedicated to gynaecological cancers management.
5.3.3 Summary of available scientific evidence LoE 2+
Impact of physician specialty on survival: Vernooij et al.228 and du Bois et al.209 performed
systematic reviews of the literature to evaluate notably whether physician-related variables have any
impact on outcome in advanced ovarian cancer patients. Vernooij et al.228 included 11
studies210,224,229-237. du Bois et al.209 also included 11 studies229-231,233,234,237-242 6 studies were
included in the 2 systematic reviews229-231,233,234,237.
Due to great heterogeneity of the studies, the authors could not quantitatively summarize the survival
to determine whether surgery performed by a gynecologic oncologist led to an overall improved
survival or not. Among the included studies, only 6 studies229,231,234,237,239,242 analyzed the
independent prognostic value of physician specialty on survival Table 7. Multivariate analyses
showed that surgery performed by gynecologic oncologists was found to be independently
prognostic for survival in 2 studies229,237 after adjustment for 1 age, grade, histology, ascites, and
socioeconomic status229 or 2 age, grade, histology, ascites, performance status, CA 125,
comorbidity, and residual disease237.
Six studies24,28-30,39,40,43 compared survival in patients with advanced ovarian cancer after treatment
by general surgeon with survival after treatment by obstetricians/general gynecologists229,231,234,237-
239,243. Three of these 6 studies76,80,90 showed that survival was worse among patients treated by
general surgeon and 2 studies29,30 reported an independent significant impact of surgery performed
by a general surgeon on survival229,234 after adjustment for age, grade, histology, ascites, and
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