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Original research
SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer
  1. Felix Boria1,
  2. Luis Chiva1,
  3. Enrique Chacon2,
  4. Vanna Zanagnolo3,
  5. Anna Fagotti4,5,
  6. Ali Kucukmetin6,
  7. Constantijne Mom7,
  8. Galina Chakalova,8,
  9. Aliyev Shamistan9,
  10. Mario Malzoni10,
  11. Fabrice Narducci11,
  12. Octavio Arencibia12,
  13. Francesco Raspagliesi13,
  14. Tayfun Toptas14,
  15. David Cibula15,
  16. Dilyara Kaidarova16,
  17. Mehmet Mutlu Meydanli17,
  18. Mariana Tavares18,
  19. Dmytro Golub19,
  20. Anna Myriam Perrone20,
  21. Robert Poka21,
  22. Petra L M Zusterzeel22,
  23. Igor Aluloski23,
  24. Frederic Goffin24,
  25. Dimitrios Haidopoulos25,
  26. Herman Haller26,
  27. Robert Jach27,
  28. Iryna Yezhova28,
  29. Margarida Bernardino29,
  30. Rasiah Bharathan30,
  31. Minna M Maenpaa31,
  32. Vladyslav Sukhin32,33,
  33. Jean-Guillaume Feron34,
  34. Robert Fruscio35,36,
  35. Kersti Kukk37,
  36. Jordi Ponce38,
  37. Fuat Demirkiran39,
  38. George Vorgias40,
  39. Natalia Povolotskaya41,
  40. Pluvio J Coronado Martín42,
  41. Tiermes Marina43,
  42. Ignacio Zapardiel44,
  43. Nicolò Bizzarri45,
  44. Mikel Gorostidi46,
  45. Monica Gutierrez1,
  46. Nabil Manzour2,
  47. Arantxa Berasaluce47 and
  48. Nerea Martin-Calvo48
  49. On behalf of the SUCCOR study Group
  1. 1 Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
  2. 2 Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
  3. 3 Istituto Europeo di Oncologia, Milan, Italy
  4. 4 Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  5. 5 Catholic University of the Sacred Heart, Milano, Lombardia, Italy
  6. 6 Queen Elizabeth Hospital, Gateshead, Gateshead, UK
  7. 7 Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
  8. 8 University Oncologic Hospital, Sofia, Bulgaria
  9. 9 National Center of Oncology, Baku, Azerbaijan
  10. 10 Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
  11. 11 Department of Gynecology, Centre Oscar Lambret, Lille, France
  12. 12 Department of Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Las Palmas, Spain
  13. 13 Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  14. 14 Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
  15. 15 Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
  16. 16 Department of Oncogynecology, Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
  17. 17 Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
  18. 18 IPO-PORTO, Porto, Portugal
  19. 19 Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv Region, Ukraine
  20. 20 Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
  21. 21 Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  22. 22 Department of Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
  23. 23 Department of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopjeskopje, Macedonia
  24. 24 Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
  25. 25 Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
  26. 26 Clinical Hospital Center Rijeka, Rijeka, Croatia
  27. 27 Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
  28. 28 Lviv Oncology Center, Lviv, Ukraine
  29. 29 Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
  30. 30 University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
  31. 31 Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
  32. 32 Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine
  33. 33 Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
  34. 34 Institut Curie, Paris, Île-de-France, France
  35. 35 Department of Medicine and Surgery, University of Milan–Bicocca, Milan, Italy
  36. 36 Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
  37. 37 North Estonia Medical Centre, Tallinn, Estonia
  38. 38 Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
  39. 39 Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
  40. 40 Metaxa Cancer Hospital of Piraeus, Piraeus, Attika, Greece
  41. 41 Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
  42. 42 Department of Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
  43. 43 Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
  44. 44 Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
  45. 45 UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
  46. 46 Hospital Universitario Donostia, San Sebastian, Spain
  47. 47 Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
  48. 48 ,Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
  1. Correspondence to Dr Luis Chiva, Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, MADRID, Spain; lchiva{at}unav.es

Abstract

Objective To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer.

Methods In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort.

Results A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy.

Conclusions Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.

  • cervical cancer
  • gynecologic surgical procedures
  • hysterectomy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/ijgc-2022-003790

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @BoriaFelix, @Quique_ChC, @annafagottimd, @r.bolatbekova@gmail.com, @RasiahBharathan, @Tiermes, @mgorostidi

    • Correction notice This article has been corrected since it was first published. The author Nerea Martin-Calvo was omitted from the manuscript in error and has now been added to the article.

    • Collaborators On behalf of the SUCCOR study group: Nabil Abdalla, Sedat Akgöl, Demirkiran Aksahin, Shamistan Aliyev, Maria Alonso-Espias, Claudia Andrade, Nikola Badzakov, Rosa Barrachina, Giorgio Bogani, Eduard-Aexandru Bonci, Hélène Bonsang-Kitzis, Cosima Brucker, Laura Cárdenas, Andrea Casajuana, Pere Cavalle, Jorge Cea, Benito Chiofalo, Gloria Cordeiro, Maria Cuadra, Javier Díez, Teresa Diniz da Costa, Santiago Domingo, Lukas Dostalek, Fuat Elif, Diego Erasun, Mathias Fehr, Sergi Fernandez-Gonzalez,Annamaria Ferrero, Soledad Fidalgo, Gabriel Fiol, Khadra Galaal, José García, Gerhard Gebauer, Fabio Ghezzi, Juan Gilabert, Nana Gomes, Elisabete Gonçalves, Virginia Gonzalez, Frederic Grandjean, Miriam Guijarro, Frédéric Guyon, Jolien Haesen, Gines Hernandez-Cortes, Sofía Herrero, Imre Pete, Ioannis Kalogiannidis, Erbil Karaman, Andreas Kavallaris, Lukasz Klasa, Ioannis Kotsopoulos, Stefan Kovachev, Uppin Arno Leht, Arantxa Lekuona, Mathieu Luyckx, Michael Mallmann, Gemma Mancebo, Aljosa Mandic, Victor Martin, María Belén Martín-Salamanca, Víctor Lago, Alejandra Martinez, Gesine Meili, Gustavo Mendinhos, Liliana Mereu, Milena Mitrovic, Sara Morales, Enrique Moratalla, Natalia R. Gómez-Hidalgo, Bibiana Morillas, Eva Myriokefalitaki, Maja PakižImre, Imre Pete, Stamatios Petousis, Laurentiu Pirtea, Natalia Povolotskaya, Sonia Prader, Alfonso Quesada, Mikuláš Redecha, Fernando Roldan, Philip Rolland, Reeli Saaron, Cosmin-Paul Sarac, Jens-Peter Scharf, Špela Smrkolj, Rita Sousa, Artem Stepanyan, Vladimír Študent, Carmen Tauste, Hans Trum, Taner Turan, Manuela Undurraga, Alicia Vázquez and Ignace Vergote.

    • Contributors All authors contributed meaningfully to the conception or design of the work or the acquisition, analysis, or interpretation of data for the study. The authors confirm the completeness and accuracy of the data and analyses, the fidelity of the study to the protocol, and the final approval of the version to be published. LC is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.