Quality standard
Quality statement 8: Optimal surgical staging
Quality statement 8: Optimal surgical staging
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements and written clinical protocols to ensure women with suspected stage I ovarian cancer have optimal surgical staging.
Data source: Local data collection.
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.
Data source: National Cancer Outcomes and Services Dataset, available from the National Cancer Intelligence Network.
b) Proportion of women with stage I ovarian cancer that had upfront systematic retroperitoneal lymphadenectomy.
Numerator – the number of women in the denominator who had upfront systematic retroperitoneal lymphadenectomy.
Denominator – the number of women with stage I ovarian cancer.
Upfront systematic retroperitoneal lymphadenectomy is not recommended for women with stage I ovarian cancer, and therefore an audit standard of 0% should be expected in this process measure.
Data source: National Cancer Outcomes and Services Dataset, available from the National Cancer Intelligence Network.
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
Ovarian cancer: recognition and initial management. NICE guideline CG122 (2011), recommendations 1.3.1.2, 1.3.2.1 (key priorities for implementation) and 1.3.1.1
Definitions of terms used in this quality statement
Optimal surgical staging
Optimal surgical staging does not include upfront systematic retroperitoneal lymphadenectomy. NICE's guideline on ovarian cancer states systematic retroperitoneal lymphadenectomy should not be included as part of standard surgical treatment for women who appear to have stage I disease.
NICE's guideline on ovarian cancer 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
-
retroperitoneal lymph node assessment.
[Adapted from the NICE guideline on ovarian cancer, recommendation 1.3.1.1]