Page 9 - Ovarian Cancer Surgery - Quality Indicators

5 QIs for advanced ovarian cancer surgery

5.1 QI 1 - Rate of complete surgical resection

5.1.1 Description of the QI

TYPE Outcome indicator.

DESCRIPTION Complete abdominal surgical resection is defined by the absence of remaining
macroscopic lesions after careful exploration of the abdomen. Whenever feasible,
localized thoracic disease is resected. Surgery can be decided upfront, or planned after
neoadjuvant chemotherapy. However, the quality assurance program must take into
account that patients who can be operated upfront with a reasonable complication rate
benefit most from primary debulking surgery.

SPECIFICATIONS i) Complete resection rate:
 Numerator: number of patients with advanced ovarian cancer undergoing complete

surgical resection.

 Denominator: all patients with advanced ovarian cancer referred to the center.
ii) Proportion of patients who are operated upfront :

 Numerator: patients who are offered upfront surgery.
 Denominator: all patients not previously treated.

TARGETS i) Complete resection rate:
 Optimal target: > 65%.
 Minimum required target:> 50%.
ii) Proportion of p rimary debulking surgeries: ≥50%

SCORING RULE i) 5 if the optimal target is met, 3 if the minimum required target is met
ii) 3 if the target is met.

5.1.2 Rationale

Surgery remains a key determinant of survival outcome in advanced ovarian cancer. The size of residual disease
after cytoreductive surgery is estimated as the largest diameter of remaining tumor and is one of the most
important prognostic factors.

According to the 4th international gynecologic cancer intergroup ovarian cancer consensus conference 2010
held in Vancouver119, the term “optimal” cytoreduction should be reserved for those with no macroscopic
residual disease. This corresponds to the definition of complete surgery.

Five previous initiatives26,46,53,64,118 published a QI for this topic. No remaining macroscopic lesions was used as
surgery criterion by three of these five previous initiatives46,53,64. An optimal primary cytoreduction as defined
above is recommended by the six guidelines120-125 identified for this subtopic and an optimal delayed
cytoreduction is recommended by the two guidelines124,126 identified for this subtopic.

 OVARIAN CANCER SURGERY - QUALITY INDICATORS 
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