Querleu D, Narducci F
Société Française d'Oncologie Gynécologique, Institut Claudius-Regaud, 20-24 Rue du Pont-Saint-Pierre, 31052 Toulouse, France.
Bull Cancer. 2009 Dec;96(12):1255-62. doi: 10.1684/bdc.2009.0990.
Two concurrent policies can be proposed to improve the quality of care for ovarian cancer surgery: organization of care, audit. The two policies are not to be opposed: the efficacy of any policy must be audited, targets are more rapidly reached and more easily audited when an underlying organization is available. However, the arbitrary definition of criteria is a challenge. The interpretation of results depends on the context of each individual center. There is a definite risk of unwanted effects: competition to reach the cut-off if quantitative caseload criteria are demanded, reduction of the quality of cytoreduction if the complication rate is included, selection of patients if the rate of complete cytoreduction is chosen as a major parameter. Quality control must encompass the standard of preoperative workup, the quality of operative report, the complication rate and the oncological outcome. Although quantitative yearly caseload requirements may contribute to the quality of care, it seems more pertinent to recall the prerequisites that the surgeon must fulfil before undertaking a surgery for ovarian cancer. Knowledge of the specific features of the disease and of all the components of its medical management, skills in general surgical procedures required to complete staging and cytoreduction, and contribution to a multidisciplinary team involved in clinical research are mandatory. Even though no definitive proof is available, the available information tend to show a superiority of the standard of surgical care provided by experienced or specialized surgeons.
护理组织和审计。这两项政策并非相互对立：任何政策的效果都必须接受审计，当有一个基础组织时，目标能更快实现且更易于审计。然而，标准的随意定义是一项挑战。结果的解释取决于每个中心的具体情况。存在不良影响的明确风险：如果要求有定量病例量标准，为达到临界值会产生竞争；如果将并发症发生率包括在内，细胞减灭术的质量会降低；如果选择完全细胞减灭率作为主要参数，会导致患者的选择偏差。质量控制必须涵盖术前检查的标准、手术报告的质量、并发症发生率和肿瘤学结果。虽然每年的定量病例量要求可能有助于提高护理质量，但似乎更有必要回顾外科医生在进行卵巢癌手术前必须满足的先决条件。了解该疾病的具体特征及其医疗管理的所有组成部分、完成分期和细胞减灭所需的普通外科手术技能，以及对参与临床研究的多学科团队做出贡献是必不可少的。尽管尚无确凿证据，但现有信息倾向于表明经验丰富或专业的外科医生所提供的手术护理标准更具优势。
