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The standardization of surgical outcomes throughout surgical procedures is mandatory. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) should provide proficient oncological and surgical outcomes.The aim of this study was to identify clinically relevant quality indicators and their quality standard, and to determine their acceptable quality limit. A systematic review on cytoreductive results from 2000 to 2018 was performed focusing on clinical guidelines, consensus conferences, and publications. After the selection of quality indicators, a systematic review of indexed references was performed in order to calculate the quality standard for each indicator.Unicentric/multicentric series, comparative studies, and clinical trials. Studies were to include outcomes after cytoreduction of colorectal origin and series with more than 50 patients. Quality indicators with at least 10 series were mandatory and objective measurements were also mandatory for inclusion.Quality indicators selected were 1- to 5-year survival, overall disease-free survival, 1- to 5-year disease-free survival, complete surgical resection, duration of surgery, length of stay, overall morbimortality, major morbidity, re-intervention, postoperative hemorrhage, intestinal fistula, anastomotic leakage, wound infection, postoperative medical complications, overall recurrence, and failure to rescue.The most relevant quality indicators and critical quality limits were overall disease-free survival and 5-year overall disease-free survival (14 months and10 months, and 14% and4%, respectively), completeness of surgical resection (89% and80%, respectively), overall mortality (3% and8%, respectively), overall morbidity (47% and63%, respectively), failure to rescue (12% and30%, respectively), reintervention (13 and22%, respectively), anastomotic leakage (6% and13%, respectively), and overall recurrence (60% and74%, respectively).This is the first study to assess quality standards in CRS + HIPEC for colorectal peritoneal metastases. The current data are of particular relevance for future studies to control the variability of this surgery.

To identify quality indicators and establish acceptable quality limits (AQLs) in pancreatic oncologic surgery using a formal statistical methodology.Indicators have been identified through systematic literature reviews and guidelines for pancreatic surgery. AQLs were determined for each indicator with confidence intervals of 99.8 and 95 % above and below the weighted average by sample size from the different series examined.Several indicators have been identified with the following results as AQLs: resectability rate59 %; morbidity, mortality, and pancreatic fistula rate in pancreaticoduodenectomy55,5, and16 %, respectively; morbidity, mortality, and fistula rate in distal pancreatectomy53,4, and31 %, respectively; number of lymph nodes retrieved15; R1 resection46 %; survival at 1, 3, and 5 years54,19, and8 %, respectively.A series of different indicators for quality surgical care outcome in pancreatic cancer, as well as their limits, have been determined according to a standard methodology.