Large-scale regional assessment of surgical volumes and European Society of Gynaecological Oncology quality indicators for ovarian cancer surgery in Italy

Objective: This study aimed to evaluate the adherence of ovarian cancer care in Lombardy, Italy to European Society of Gynaecological Oncology (ESGO) quality indicators and identify organizational strengths and gaps within the regional service delivery. Methods: A cross-sectional assessment was conducted and distributed to all 111 hospitals in Lombardy between January 15 and March 15, 2024. The survey, based on ESGO quality indicators, examined surgical volume, access to multi-disciplinary tumor boards, peri-operative resources, and molecular diagnostics. Surgical volumes from 2022 to 2023 were cross-validated using administrative data (International Classification of Diseases and Current Procedural Terminology codes). Institutions were categorized by annual procedure volume: <10, 10 to 24, 25 to 49, and ≥50 surgeries per year. Adherence to ESGO standards was analyzed across these strata. Results: A total of 52 hospitals reported performing ovarian cancer surgeries during the study period, totaling 1866 procedures. Only 8 centers (15.4%) met the ESGO quality criteria, yet they managed 64.4% of patients, indicating partial centralization. Although 71.2% of hospitals used dedicated gynecologic oncologists and 78.8% had functional multi-disciplinary tumor boards, BRCA and homologous recombination deficiency testing were available in only 44.2% and 38.5% of centers, respectively. A substantial number of patients were still treated in low-volume centers (<10 surgeries per year), raising concerns about surgical expertise and outcome quality. In addition, prospective documentation of surgical outcomes and complications was inconsistently implemented. Conclusions: Ovarian cancer care in Lombardy is partially centralized, with high-volume centers managing most cases and generally adhering to ESGO indicators. However, disparities persist in molecular testing, peri-operative outcome documentation, and equitable access to high-standard care. Strategic investments in diagnostics, referral networks, and data infrastructure are essential to optimize regional outcomes.