Quality statement 8: Optimal surgical staging

Quality statement

Women with suspected stage I ovarian cancer have optimal surgical staging.

Quality measure

Structure: Evidence of local arrangements and written clinical protocols to ensure women with suspected stage I ovarian cancer have optimal surgical staging.

Process:

a) Proportion of women with stage I ovarian cancer that had optimal surgical staging.

Numerator – the number of women in the denominator who had optimal surgical staging.

Denominator – the number of women with stage I ovarian cancer.

b) Proportion of women with stage I ovarian cancer that had up-front systematic retroperitoneal lymphadenectomy.

Numerator – the number of women in the denominator who had up-front systematic retroperitoneal lymphadenectomy.

Denominator – the number of women with stage I ovarian cancer.

Up-front systematic retroperitoneal lymphadenectomy is not recommended for women with stage I ovarian cancer therefore an audit standard of 0% should be expected in this process measure.

What the quality statement means for each audience

Service providers ensure systems are in place for women with suspected stage I ovarian cancer to have optimal surgical staging.

Healthcare professionals ensure women with suspected stage I ovarian cancer have optimal surgical staging.

Commissioners ensure they commission services in which women with suspected stage I ovarian cancer have optimal surgical staging.

Women with suspected stage I ovarian cancer (which is cancer that has not spread from the ovaries) have surgery (known as optimal surgical staging) that involves removing the cancerous tissue and making a full assessment of the stage of the cancer.

Source guidance

NICE clinical guideline 122 recommendations 1.3.1.2 and 1.3.2.1 (key priorities for implementation) and 1.3.1.1.

Data source

Structure: Local data collection.

Process: a) and b) National Cancer Outcomes and Services Dataset (in development), available from the National Cancer Intelligence Network.

Also contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): secondary care, criteria 9 and 10.

Definitions

Optimal surgical staging does not include up-front systematic retroperitoneal lymphadenectomy. NICE clinical guideline 122 states systematic retroperitoneal lymphadenectomy should not be included as part of standard surgical treatment for women who appear to have stage I disease.

NICE clinical guideline 122 defines the constituents of optimal surgical staging as: midline laparotomy to allow thorough assessment of the abdomen and pelvis; a total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy; biopsies of any peritoneal deposits; random biopsies of the pelvic and abdominal peritoneum; and retroperitoneal lymph node assessment.