Department of Gynecologic Oncology, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy.
Department of Gynecologic Surgery, European Institute of Oncology, IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
J Gynecol Oncol. 2022 Sep;33(5):e60. doi: 10.3802/jgo.2022.33.e60. Epub 2022 Jun 3.
The European Society of Gynaecological Oncology (ESGO)-quality indicators (QIs) for advanced ovarian cancer (AOC) have been assessed only by few Italian centers, and data are not available on the proportion of centers reaching the score considered for a satisfactory surgical management. There is great consensus that the Enhanced Recovery After Surgery (ERAS) approach is beneficial, but there is paucity of data concerning its application in AOC. This survey was aimed at gathering detailed information on perioperative management of AOC patients within MITO-MaNGO Groups.
A 66-item questionnaire, covering ESGO-QIs for AOC and ERAS items, was sent to MITO/MaNGO centers reporting to operate >20 AOC/year.
Thirty/34 questionnaires were analyzed. The median ESGO-QIs score was 31.5, with 50% of centers resulting with a score ≥32 which provides satisfactory surgical management. The rates of concordance with ERAS guidelines were 46.6%, 74.1%, and 60.7%, respectively, for pre-operative, intra-operative, and post-operative items. The proportion of overall agreement was 61.3%, and with strong recommendations was 63.1%. Pre-operative diet, fasting/bowel preparation, correction of anaemia, post-operative feeding and early mobilization were the most controversial. A significant positive correlation was found between ESGO-QIs score and adherence to ERAS recommendations.
This survey reveals a satisfactory surgical management in only half of the centers, and an at least sufficient adherence to ERAS recommendations. Higher the ESGO-QIs score stronger the adherence to ERAS recommendations, underlining the correlations between case volume, appropriate peri-operative management and quality of surgery. The present study is a first step to build a structured platform for harmonization within MITO-MaNGO networks.
欧洲妇科肿瘤学会（ESGO）的高级卵巢癌（AOC）质量指标（QIs）仅由少数意大利中心进行评估，并且没有关于达到被认为是满意手术管理的分数的中心比例的数据。人们普遍认为，术后强化康复（ERAS）方法是有益的，但关于其在 AOC 中的应用的数据很少。这项调查旨在收集 MITO-MaNGO 组内 AOC 患者围手术期管理的详细信息。
向报告每年进行> 20 例 AOC 手术的 MITO/MaNGO 中心发送了一份包含 66 个项目的问卷，涵盖了 ESGO-AOC 和 ERAS 项目的 QIs。
分析了 30/34 份问卷。ESGO-QIs 中位数为 31.5，50%的中心得分为≥32，提供满意的手术管理。与 ERAS 指南的一致性率分别为术前、术中、术后项目的 46.6%、74.1%和 60.7%。总体一致性比例为 61.3%，强烈推荐的比例为 63.1%。术前饮食、禁食/肠道准备、纠正贫血、术后喂养和早期活动是最具争议的。ESGO-QIs 评分与 ERAS 建议的依从性呈显著正相关。
这项调查显示，只有一半的中心达到了满意的手术管理水平，并且至少足够遵守 ERAS 建议。ESGO-QIs 评分越高，对 ERAS 建议的依从性越强，这突显了病例量、适当的围手术期管理和手术质量之间的相关性。本研究是在 MITO-MaNGO 网络内建立结构化协调平台的第一步。
