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3.1 Nomination of multidisciplinary international development group

The ESGO Council nominated practicing clinicians that provide care to advanced ovarian cancer patients and
had demonstrated leadership in quality improvement through research, administrative responsibilities, or
committee membership to serve as experts panel. The objective was to assemble a multidisciplinary panel,
including one surgical and one methodologic co-chairs. It was therefore essential to include professionals on the
panel from relevant disciplines so that their multidisciplinary perspective would influence the validity and
acceptability of the chosen indicators surgery, medical oncology, pathology, radiology, anaesthesiology,
gynecology, radiation oncology. Another requirement was a balanced representativity of countries across
Europe. The list of international experts development group is available in Appendix 1 .1.

3.2 Identification of potential QIs

All possible QIs for advanced ovarian cancer surgery were identified from existing guidelines and published
indicators. A systematic literature search was conducted in MEDLINE without any restriction in the search
period, using indexing terms as follows: quality indicators, ovarian cancer, surgery, methodology, guidelines,
evidence-based medicine. An another bibliographic search was carried out using selected websites to identify
guidelines. References were selected if they described indicators developed by other agencies or synthesized
research evidence describing practice contributing to improved patient outcomes guidelines or consensus
statements. Five previous initiatives publishing QIs for advanced ovarian cancer surgery were
identified26,46,53,64,118. The surgical and methologic co-chairs compiled a list of 15 possible indicators:

1. Inclusion in the surgical team of a medical oncologist  9. Midline laparotomy
2. Surgery performed by a gynecologic oncologist           10. Volume of ovarian surgery
3. Inclusion of patients in clinical trials                11. Pathology report
4. Delay between the decision to treat and treatment       12. Operative report
5. Pelvic and para-aortic lymphadenectomy                  13. Intraoperative frozen sections
6. Pretreatment multidisciplinary decision-making process  14. Complete surgical resection
7. Anaesthetic management                                  15. Perioperative investigations
8. Prospective reporting of complications

3.3 Identification of scientific evidence

A systematic literature search was conducted in MEDLINE to identify available scientific evidence which
supports the 15 possible QIs research period: 2005/01/01 - 2015/04/01. This search used indexing terms as
follows: anaesthesiology, clinical competence, clinical studies, clinical trials, complete resection, cytoreduction,
cytoreductive surgery, debulking, decision making, delayed cytoreduction, delayed cytoreductive surgery, frozen
sections, hospital teaching, hospital mortality, hospital volume, hospital university, in-hospital death, intensive
care, intensive care unit, laparoscopy, laparotomy, length of stay, lymphadenectomy, lymph node dissection,
medical audit, medical records, medical standards, mortality rate, mortality analysis, multidisciplinary team,
multidisciplinary team approach, multivariate analysis, nutrition assessment, nutritional status, nutritional
support, operation, operative report, operative report documentation, optimal cytoreduction, ovarian cancer,
ovarian neoplasm, ovarian tumour, ovariectomy, para-aortic lymphadenectomy, pathology, pathology report,
pathology report adequacy, pelvic lymphadenectomy, perioperative care, physician’s role, physician specialty,
postoperative care, postoperative complications, preoperative care, preoperative workup, primary cytoreduction,
primary cytoreductive surgery, prognosis, quality of health care, quality of life, reoperation, repeat surgery,
reporting, resection, residual disease, residual tumour, risk factors, specialization, suboptimal cytoreduction,
surgeon volume, surgery, surgical management, surgical outcome, surgical outcome criteria, surgical procedures,
surgical resection, survival rate, survival analysis, treatment outcome.

 OVARIAN CANCER SURGERY - QUALITY INDICATORS 
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