Article Text

Download PDFPDF

European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery
  1. Denis Querleu, MD*,
  2. François Planchamp, MSc*,
  3. Luis Chiva, MD,
  4. Christina Fotopoulou, MD,
  5. Desmond Barton, MD§,
  6. David Cibula, MD,
  7. Giovanni Aletti, MD,
  8. Silvestro Carinelli, MD,
  9. Carien Creutzberg, MD#,
  10. Ben Davidson, MD, PhD**,
  11. Philip Harter, MD††,
  12. Lene Lundvall, MD‡‡,
  13. Christian Marth, MD§§,
  14. Philippe Morice, MD, PhD∥∥,
  15. Arash Rafii, MD, PhD¶¶,
  16. Isabelle Ray-Coquard, MD, PhD##,
  17. Andrea Rockall, MD,
  18. Cristiana Sessa, MD***,
  19. Ate van der Zee, MD†††,
  20. Ignace Vergote, MD‡‡‡ and
  21. Andreas du Bois, MD††
  1. *Institut Bergonié, Bordeaux, France;
  2. MD Anderson Cancer Center, Madrid, Spain;
  3. Imperial College London;
  4. §Royal Marsden Hospital, London, United Kingdom;
  5. Charles University Hospital, Prague, Czech Republic;
  6. European Institute of Oncology, Milan, Italy;
  7. #Leiden University Medical Center, Leiden, the Netherlands;
  8. **Norwegian Radium Hospital, Oslo, Norway;
  9. ††Kliniken Essen-Mitte, Essen, Germany;
  10. ‡‡Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;
  11. §§Innsbrück Medical University, Innsbruck, Austria;
  12. ∥∥Institut Gustave Roussy, Villejuif, France;
  13. ¶¶Weill Cornell Medical College, Doha, Qatar;
  14. ##Centre Leon Berard, Lyon, France;
  15. ***Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;
  16. †††University Medical Center, Groningen, the Netherlands; and
  17. ‡‡‡University Hospital Leuven, Catholic University Leuven, Leuven, European Union, Belgium.
  1. Address correspondence and reprint requests to Denis Querleu, MD, Institut Bergonié, 229 Cours de l’Argonne, 33000 Bordeaux, France. E-mail:


Objectives The surgical management of advanced ovarian cancer involves complex surgery. Implementation of a quality management program has a major impact on survival. The goal of this work was to develop a list of quality indicators (QIs) for advanced ovarian cancer surgery that can be used to audit and improve the clinical practice. This task has been carried out under the auspices of the European Society of Gynaecologic Oncology (ESGO).

Methods Quality indicators were based on scientific evidence and/or expert consensus. A 4-step evaluation process included a systematic literature search for the identification of potential QIs and the documentation of scientific evidence, physical meetings of an ad hoc multidisciplinarity International Development Group, an internal validation of the targets and scoring system, and an external review process involving physicians and patients.

Results Ten structural, process, or outcome indicators were selected. Quality indicators 1 to 3 are related to achievement of complete cytoreduction, caseload in the center, training, and experience of the surgeon. Quality indicators 4 to 6 are related to the overall management, including active participation to clinical research, decision-making process within a structured multidisciplinary team, and preoperative workup. Quality indicator 7 addresses the high value of adequate perioperative management. Quality indicators 8 to 10 highlight the need of recording pertinent information relevant to improvement of quality. An ESGO-approved template for the operative report has been designed. Quality indicators were described using a structured format specifying what the indicator is measuring, measurability specifications, and targets. Each QI was associated with a score, and an assessment form was built.

Conclusions The ESGO quality criteria can be used for self-assessment, for institutional or governmental quality assurance programs, and for the certification of centers. Quality indicators and corresponding targets give practitioners and health administrators a quantitative basis for improving care and organizational processes in the surgical management of advanced ovarian cancer.

  • Ovarian cancer
  • Cytoreduction
  • Quality assurance

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The project has been initiated by the European Society of Gynaecologic Oncology (ESGO), which has provided administrative and meeting expenses support. The decision to elaborate a set of quality assurance criteria has been made by the Guidelines and Quality Assurance of the ESGO, with the approval of the ESGO Council. The only external funding source was a grant from the Institut National du Cancer (INCa, Paris, France). The ESGO is a nonprofit knowledgeable society. The INCa is a French government agency.

  • The authors declare no conflicts of interest.

  • Andreas du Bois and Ignace Vergote contributed equally to this work.

  • The working group (including all authors) is collectively responsible for the decision to submit for publication. Denis Querleu and François Planchamp have chaired the working group as a physician and a methodologist, respectively. They have written the first draft of the manuscript. Systematic literature search was completed by François Planchamp. All other contributors have actively participated to the working group, given personal input, reviewed the manuscript, and have given final approval before submission.

  • Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (