Page 3 - Guidelines Ovarian Surgery

To ensure that the statements made in this document are evidence-based, the current literature was reviewed
and critically appraised. A comprehensive literature review of the studies published between January 2005 and
May 2016 was carried out.
The guidelines were retained if they were supported by sufficient high-level scientific evidence and/or when a
large consensus among experts was obtained. By default, a guideline is the standard clinical approach. If an
approach is judged to be acceptable but is not unanimously recognized as a criterion-standard clinical approach,
indication is given that it is still subject to discussion and/or evaluation.
These guidelines have five different “strength of guideline” ratings (SIGN grading system1):

A At least one meta-analysis, systematic review, or RCT rated as 1++ and directly applicable to the target

population; or
A body of evidence consisting principally of studies rated as 1+, directly applicable to the target
population, and demonstrating an overall consistency of results.

B A body of evidence including studies rated as 2++, directly applicable to the target population,

and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 1++ or 1+.

C A body of evidence including studies rated as 2+, directly applicable to the target population

and demonstrating overall consistency of results; or
Extrapolated evidence from studies rated as 2++.

D Evidence level 3 or 4; or

Extrapolated evidence from studies rated as 2+.

✓ Recommended best practice based on the clinical experience of the guideline development group.

1++ high quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias; 1+ well
conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias; 2++ high quality systematic reviews of case control or cohort
studies/high quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship
is causal; 2+ well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the
relationship is causal; 3 non-analytic studies, e.g., case reports, case series; 4 expert opinions.

1 http://www.sign.ac.uk/guidelines/fulltext/50/annexoldb.html

• OVARIAN CANCER SURGERY - GUIDELINES • 3