Quality Improvement in the Surgical Approach to Advanced Ovarian Cancer: The Mayo Clinic Experience

Aletti, Giovanni; Dowdy, Sean C.; Gostout, Bobbie S.; Jones, Monica B.; Stanhope, Robert C.; Wilson, Timothy O.; Podratz, Karl C.; Cliby, William A.

doi:10.1016/j.jamcollsurg.2009.01.006

Cited by 99 publications

(86 citation statements)

References 20 publications

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“…This procedure also occurred more commonly at primary cytoreductive procedures: in the most recent 5-year period 73% occurred in the primary setting vs. 57% between 1995 and 1999. In a recent internal quality assessment of ovarian cancer surgery at our institution, we noted an increase in the utilization of all diaphragmatic procedures at primary surgery from 23% of cases with diaphragm involvement in the period between 1994 and 1998 to 59% in 2006 (unpublished, internal data) [24].…”

Section: Resultsmentioning

confidence: 81%

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Dowdy

Loewen

Aletti

et al. 2008

Gynecologic Oncology

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Objective-To describe the technique of diaphragmatic peritonectomy (DP) for ovarian cancer cytoreduction and to assess associated morbidity.Methods-Retrospective review yielded 56 patients who underwent DP as part of a cytoreductive procedure for primary or recurrent ovarian cancer between 1988 and 2004. Patients who underwent diaphragmatic resection, removal of diaphragmatic implants with CUSA, cautery, curette, or finger fracture, and patients with pseudomyxoma were excluded from analysis.Results-DP was performed as a component of primary or secondary cytoreduction in 37 (66%) and 19 (34%) patients, respectively. Extended procedures including bowel resection, hepatic resection, splenectomy, or radical hysterectomy were performed with DP in 47 patients (82%). Resection of all disease > 1 cm was achieved in 95% (microscopic residuum in 43%). For those undergoing primary cytoreduction, median survival was 59 months and 5-year survival was 49% with median follow-up of 34 months. When performed for recurrent ovarian carcinoma, 5-year survival was 16% and median survival was 23 months. No intra-operative complications could be specifically attributed to DP. Post-operative complications included a 30% rate of pleural effusion which was associated with entry into the pleural space during DP (p<0.0001); thoracentesis was required in 12.5%.Conclusions-Diaphragmatic metastases are a common obstacle to optimal cytoreduction for patients with ovarian cancer. When necessary, utilizing DP in concert with other extended procedures to obtain maximal cytoreduction is associated with excellent survival. It should be recognized that DP is associated with an increased incidence of post-operative pleural effusion, particularly when the pleural space is entered.

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Section: Resultsmentioning

confidence: 81%

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Dowdy

Loewen

Aletti

et al. 2008

Gynecologic Oncology

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“…In this study, ECS is defined in accordance to NICE guidelines, [22] with patient inclusion in this group determined by having a surgical complexity score (SCS) ≥5; calculated using the Mayo Clinic Surgical Complexity Score (SCS) scoring system [30].…”

Section: Methodsmentioning

confidence: 99%

The Impact of Extensive Cytoreductive Surgery for Ovarian Cancer on the Histopathology Laboratory Workload

Elmasry¹,

El‐Bahrawy²

2017

J Cytol Histol

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Objectives: Cytoreductive surgery is the principal management for ovarian cancer. Recently there has been progressive change to more extensive cytoreductive surgery (ECS) as evidence shows this improves patient prognosis. The aim of this study is to investigate the change in histopathology work load with change in surgical practice for the treatment of ovarian cancer patients at Hammersmith Hospital, UK. Materials and methods:Specimens for patients with ovarian cancer (n=116) were selected and classified into three groups: (i) standard debulking surgery; (ii) a mix of standard debulking and ECS and (iii) ECS only. The types of specimens and numbers of blocks in each group were studied. Results:Post-hoc analysis demonstrates a statistically significant increase in the number of specimens per case from standard debulking to the mixed group (p<0.0001) and to the ECS group (p<0.0001). There is also a statistically significant increase in the number of blocks from standard debulking to the mixed (p<0.0001) and to the ECS groups (p<0.0001). Conclusion:The study shows there is a significant increase in the histopathology workload with the shift from standard to extensive cytoreductive surgery, as well as increase in the complexity and range of specimens sent for histopathological examination. It is essential that centres opting for a shift to ECS ensure that adequate provisions and resources are in place to accommodate these changes.

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“…This sometimes requires the use of bowel resection, splenectomy, diaphragmatic and peritoneal stripping. [42][43][44] Adjuvant or neoadjuvant chemotherapy with a combination of a platinum and a taxane agent has been the standard of care for epithelial ovarian cancers over the past ten years. [45] Appropriate surgery and chemotherapy have a demonstrated impact on outcomes for ovarian cancer patients and represent processes of care indicating quality.…”

Section: Processmentioning

confidence: 99%

“…[79] A quality improvement program for the surgical care of patients with advanced ovarian cancer was implemented at the Mayo Clinic using an audit and feedback approach, with the aim of increasing the proportion of patients debulked to microscopic residual disease. [44] A surgical complexity score was developed to categorize the aggressiveness of the surgical approach. [80] The quality improvement program consisted of weekly conferences where patient outcomes and treatment approaches were discussed, confidential benchmarking allowing individual surgeons to see their rates of complete surgical debulking in comparison to peers, teaching fellows and staff how to perform techniques needed for complete debulking, and intra-operative mentoring of staff and fellows by surgeons experienced in advanced procedures.…”

mentioning

confidence: 99%

In what Setting Should Women with Ovarian Cancer Receive Care?

Elit¹,

Reade²

2013

Ovarian Cancer - A Clinical and Translational Update

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Quality Improvement in the Surgical Approach to Advanced Ovarian Cancer: The Mayo Clinic Experience

Cited by 99 publications

References 20 publications

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

The Impact of Extensive Cytoreductive Surgery for Ovarian Cancer on the Histopathology Laboratory Workload

In what Setting Should Women with Ovarian Cancer Receive Care?

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