Improving ovarian cancer management through centralized surgery: experience gained by the UNGO after one year of collaboration and obtaining ESGO accreditation in 2019

Mathieu Luyckx (1,6,8), Mathieu Jouret (1,2), Frédéric Grandjean (1,3), Marc Waterkeyn (1,4), Jean-Paul Van Gossum (1,5), Nathanael Dubois (1,5), Jean-François Baurain (7,8) Jean-Luc Squifflet (1,8) Published in the journal : October 2019 Category : Gynécologie et Andrologie

Summary :

Ovarian cancer treatment combines optimal surgery with platine-based chemotherapy. The quality of the surgery, which is the cornerstone of the treatment, must be complete (no residual disease after the procedure). Owing to its central role, the European Society of Gynaecological Oncology (ESGO) has published objective criteria to evaluate the quality of surgery quality, providing gynecological oncology centers with the opportunity to be accredited for ovarian cancer surgery. In 2016, a centralisation network for ovarian cancer surgery was formed. Like others Belgian networks for rare cancers, this network primarily aimed to increase the experience of surgeons within the reference centers by increasing the number of cases, yet still enabling surgeons in other centres to perform oncological pelvic surgery and become referents of their respective centres. The UNGO (UCL Network of Gynaecological Oncology) centralizes all surgeries in the Cliniques Universitaires Saint-Luc (CUSL), with the remaing of the treatment and check-ups staying under the responsibility of collaborating centers. Five hospitals have been involved: CUSL Brussels, CHWaPi Tournai, Saint-Michel, Sainte-Elisabeth, and Saint-Jean in Brussels. After a 1-year collaboration, 40 patients underwent ovarian cancer surgery within the UNGO, and 91% of them underwent complete surgery with no residual disease (R0). The results of this first year of collaboration were deemed satisfying and we will thus continue on this path. We have thus demonstrated that centralization of ovarian cancer surgery is possible in Belgium. In 2019 the ESGO awarded for 5 years an accreditation to UNGO network and CUSL for cancer surgery advanced ovarian. Two additional centers since joined the UNGO: CSPO and Roccourt.

Key Words

Ovarian cancer, surgery, centralization

What is already known about the topic?

Multiple studies have already demonstrated that ovarian cancer prognosis is widely dependent on the quality of the performed surgery, with several criteria identified to reflect the quality of such surgery. However, a minimal number of cases proves to be mandatory in order to ensure quality. In Belgium, the vast majority of ovarian cancers are treated in centers where less than five cases of advanced stage ovarian cancer are operated on each year. This is due to the lack of systematic referral of these cases to expert centres. Surgery centralization towards a reference center within a network of collaborating hospitals, as already proposed by the KCE in their report on women cancers, is likely to be a good solution within the Belgian context. In this article, we have demonstrated in that this strategy is, in fact, feasible, enabling care quality improvements.

What does this article bring up for us?

We have demonstrated that centralizing ovarian cancer surgery is possible. This additionally enabled us to meet sufficient ESGO criteria to quickly apply for accreditation (after one year). Patients’ surgical data have been detailed, with our data compared to the ESGO criteria. Likewise, we have described our practical organisation for managing these patients.