[Quality control criteria in the surgical management of advanced ovarian cancers]

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.