In 2018 globally, the prevalence, incidence and mortality of gynaecological oncology cancers (cervix, endometrial, tubo-ovarian, vulval, vaginal) were 25.18 per 100 000 (954 439 cases), 29.35 per 100 000 (1 309 165 cases) and 13.03 per 100 000 (609 377 cases) respectively. Gynaecological cancers collectively after breast cancer account for the second greatest disease burden amongst all female cancers and by the year 2040, incidence is set to rise by 69%. 45% of all individuals diagnosed with cancer undergo surgery with curative intent. This amounts to 589 124 cases of gynaecological cancer surgery worldwide. Hence due to the current and growing disease burden of gynaecological malignancies, surgical care for gynaecological malignancies is an indispensable component of a functioning health system. However surgery has historically had a disproportionately low profile in global health priorities at the World Health Organization (WHO) due to the erroneous perception that it is a high cost intervention benefitting a small segment of society. The recent interest in surgical outcomes has been prompted by the recognition that conditions amenable to surgery such as gynaecological malignancies are important public health conditions, and that there are disparities in access to life saving and disability preventing surgeries particularly for rural and marginalised populations in lower and middle income countries (LMIC) representing unmet surgical needs. The WHO and the World Bank, have highlighted surgery as an important component for global health development.6 However, surgical care requires coordination of skilled human resources, specialised supplies and infrastructure including multicentre, international collaborations for the purpose of research to inform international policies. It is estimated that less than 25% of patients with cancer have access to safe, affordable, and timely surgery. Whilst death rates from cancer are decreasing in high income countries (HICs), the opposite is true in LMICs and up to 1.5% gross domestic product is lost because of cancer in some LMIC countries.

Despite 45% of women with gynaecological malignancies receiving surgical care with curative intent, safety and quality of care remain poorly measured and a low priority in many LMICs. In addition, there is a lack of standardised gynaecological oncology surgical data globally and a shortage of patient-level data. Gynaecological oncology surgical outcomes data, is not located or reported in any standardised way and requires information to be compiled from multiple agencies, ministries, health reports and published literature, as there is no central source for collecting or reporting. In addition, collected data does not take into account country specific epidemiological factors.

Detecting variations associated with outcomes following gynaecological oncology surgeries, and modifiable practices associated with these variations, are likely to act as surrogate markers for best performance of gynaecological oncology surgical units. Globally relevant risk factors for variations in outcomes relate to the training of the operating surgeon, availability of investigations, use of safety checklists, equipment and access to critical care facilities.

A prospective audit of surgical outcomes following gynaecological oncology surgery in the United Kingdom (UKGOSOC - United Kingdom Gynaecological Oncology Surgical Outcomes and Complications), a HIC, may lack relevance and comparability in LMICs or indeed other HICs which do not have a nationalised government funded health care system but private healthcare. Whilst the GlobalSurg collaborative has set up a consortium of general surgeons investigating surgical outcomes following general surgery, this has not included gynaecological oncology.

Objectif principal :

To evaluate international variation of post-operative morbidity and mortality following gynaecological oncology surgery between country groups defined by HDI.

Objectifs secondaires :

• To evaluate international variation between HDI country groups of intra-operative morbidity and mortality following gynaecological oncology surgery.

• To evaluate international variation between HDI country groups of histological clearance rates of gynaecological malignancies.

• To identify HDI group specific, modifiable surgical processes associated with best care taking into account resource availability/infrastructure.

• To develop best practices and standards for gynaecological oncology surgery.

• To establish an international gynaecological oncology surgical collaborative.

• To establish a prospective international database of gynaecological oncology surgical outcomes.

• To promote quality improvement and research in gynaecological oncology internationally.

• To describe variations in gynaecological oncology surgical training between HDI country groups.