Effect of quality control program on surgical management in advanced ovarian cancer.

OBJECTIVE: We investigated the effect of our quality control (QC) program on the management strategy, completeness of the surgery, and clinical outcomes in advanced ovarian cancer. METHODS: A retrospective review of medical records from January 2005 to December 2019 identified 129 patients with advanced ovarian cancer. Cases were categorized into group 1 (2005-2013) and group 2 (2014-2019) before and after implementation of the QC program. Comparisons included clinicopathological variables, operative details, recurrence and survival outcomes. RESULTS: In Group 2 (n=44), after QC program implementation, primary debulking surgery (PDS) decreased (87.1% vs. 63.6%) and interval debulking surgery (IDS) increased (12.9% vs. 36.4%), indicating a shift in surgical strategy. Optimal resection rates improved significantly for PDS in group 2 (50.0% to 75.0%, p=0.007) and remained high for IDS in both groups (81.8% vs. 81.3%, p>0.999). Post-QC, advanced debulking procedures and co-operation with other departments increased in the IDS (p<0.05). Intra/post-operative complication rates were statistically comparable (p>0.05), whereas postoperative hospital stay was significantly shorter in group 2 (17 days vs. 22 days, p=0.001). Median recurrence-free survival increased after QC, although not statistically significant (19.18 months vs. 25.38 months, p=0.855). CONCLUSION: With QC program, treatment strategies and clinical outcomes were significantly improved in advanced ovarian cancer. Systematic QC monitoring program should be considered as routine surveillance for better surgical outcomes.

Effect of Quality Control Program in Surgical Management of Early Cervical Cancer.

BACKGROUND: Regular assessments of clinical performance in gynecologic cancer surgery is important for the safety of patients. We evaluated the effects of quality control (QC) program on the treatment pattern and clinical outcomes of early cervical cancer. METHODS: Medical records of cervical cancer patients who received operation in our institution from January 2007 to December 2018 were retrospectively reviewed. Cases were divided into 2 groups, before and after the initiation of QC program, group 1 (2007-2013) and group 2 (2014-2018), based on the operation date. Two groups were compared in clinicopathologic variables, surgical methods, operative details, adjuvant treatments, recurrence and survival. RESULTS: A total of 305 cervical cancer patients were included in the analysis, 210 in group 1 and 95 in group 2. In group 2, minimally invasive surgery (MIS) was more frequently performed (60.0% vs. 76.8%, P = 0.004), especially in earlier stages (stage IA, 72.6% vs. 100.0%; stage IB, 52.2% vs. 69.5%). However, the median tumor size treated by MIS was decreased in stage IB (20 mm vs. 17 mm, P = 0.015). Frequency of adjuvant treatment was also reduced in stage IB (56.5% vs. 37.3%, P = 0.016). Recurrence within 3 years, 3-year disease free survival and overall survival did not show significant difference; however, 3-year recurrence after MIS was significantly reduced in stage IB. CONCLUSION: QC program enforced stricter patient selection criteria for MIS and positively affected clinical outcomes in cervical cancer patients who underwent surgery. Systemic monitoring should be considered for patient safety.

The Comparison of Robotic Single-Site Surgery to Single-Port Laparoendoscopic Surgery for the Treatment of Advanced-Stage Endometriosis.

Objective: To compare perioperative outcomes of robotic single-site (RSS) surgery with conventional single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis. Materials and Methods: This is a retrospective cohort study that included 120 patients who received single-port laparoendoscopic surgery or RSS surgery for the treatment of advanced-stage endometriosis at Ewha Womans University's Mokdong Hospital in Seoul, Korea between December 2014 and May 2017. Single-port laparoendoscopic cystectomy and adhesiolysis were performed in 52 patients (Single-port laparoendoscopic [SPL] group) and RSS cystectomy and adhesiolysis were performed in 68 patients (RSS group). Perioperative outcomes that we analyzed, included age, operative time, estimated blood loss, length of hospital stay, size of endometriosis, laterality of endometriosis, degree of endometriosis infiltration (i.e., deep versus not), and recurrence. Results: The patients in both groups were of similar ages. Longer operative times (107.8 ± 37.6 min for RSS group versus 76.9 ± 46.4 min for SPL group, P = .001) and more estimated blood loss (106.67 ± 171.67 mL for RSS group versus 57.1 ± 44.9 mL for SPL group, P = .001) were measured in the RSS group. However, the mean size of endometriosis was statistically larger (5.23 ± 2.53 cm for RSS group versus 4.37 ± 2.14 cm for SPL group, P = .030) and higher rates of more deeply infiltrative endometriosis (52 cases in RSS group, 76.5% versus 33 cases in SPL group, 63.5%) were observed in RSS group. Multicystic endometriosis occurred in 26 cases in the RSS group (38.2%). No significant differences were seen in terms of length of hospital stay (4.58 ± 0.61 of SPL group versus 4.59 ± 0.58 of RSS group, P = .862) or intraoperative and postoperative complications between the groups. Recurrence occurred in one case in the RSS group (1.9%). Conclusion: RSS surgery can be used in the treatment of advanced-stage endometriosis, especially in more complicated cases.