Factors associated with surgical morbidity of primary debulking in epithelial ovarian cancer
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ObjectiveEpithelial ovarian cancer (EOC) requires an aggressive surgical approach. The important part of literature on ovariancancer surgery emphasize residual tumor and survival analyses. Morbidity issue keeps in background. Therefore, weaimed to report on morbidity of cytoreductive surgery for EOC in this study. MethodsEOC patients who underwent primary debulking were evaluated. Intraoperative and postoperative complications thatoccurred within 30 days after the surgery and factors that affect morbidity were considered. ResultsThe study involved 359 patients. Forty-six intraoperative complications occurred in 42 (11.6%) patients. Advancedstage and cancer antigen level of 125 were independently and significantly associated with operative complications(hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.01–2,73; P=0.044, and HR, 1.47; 95% CI, 1.05–2.06; P=0.025,respectively). The need for intensive care unit admission was significantly higher in patients with intraoperativecomplications (28.6% vs. 8.8%, P=0.001). Intraoperative and postoperative complication rates were significantly higherin extended surgery than in standard surgery (18.9%vs. 8.5%, P=0.005 and 38.7% vs. 10.9%, P<0.001, respectively). Intraoperative and postoperative transfusion need, hospital stay duration, and chemotherapy start day were alsosignificantly higher in extended surgery than in standard surgery. Hundred postoperative complications occurred in70 patients. Age, extended surgery, presence of ascites, and presence of operative complications were independentlyand significantly associated with postoperative complications. ConclusionMorbidity of extensive surgical approach should bekept in mind in ovarian cancer surgery aimed at leavingno residual tumor. Patient-based management withan appropriate preoperative evaluation may avoidmorbidity of extended/extensive surgical approaches.
Abstract
ObjectiveEpithelial ovarian cancer (EOC) requires an aggressive surgical approach. The important part of literature on ovariancancer surgery emphasize residual tumor and survival analyses. Morbidity issue keeps in background. Therefore, weaimed to report on morbidity of cytoreductive surgery for EOC in this study. MethodsEOC patients who underwent primary debulking were evaluated. Intraoperative and postoperative complications thatoccurred within 30 days after the surgery and factors that affect morbidity were considered. ResultsThe study involved 359 patients. Forty-six intraoperative complications occurred in 42 (11.6%) patients. Advancedstage and cancer antigen level of 125 were independently and significantly associated with operative complications(hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.01–2,73; P=0.044, and HR, 1.47; 95% CI, 1.05–2.06; P=0.025,respectively). The need for intensive care unit admission was significantly higher in patients with intraoperativecomplications (28.6% vs. 8.8%, P=0.001). Intraoperative and postoperative complication rates were significantly higherin extended surgery than in standard surgery (18.9%vs. 8.5%, P=0.005 and 38.7% vs. 10.9%, P<0.001, respectively). Intraoperative and postoperative transfusion need, hospital stay duration, and chemotherapy start day were alsosignificantly higher in extended surgery than in standard surgery. Hundred postoperative complications occurred in70 patients. Age, extended surgery, presence of ascites, and presence of operative complications were independentlyand significantly associated with postoperative complications. ConclusionMorbidity of extensive surgical approach should bekept in mind in ovarian cancer surgery aimed at leavingno residual tumor. Patient-based management withan appropriate preoperative evaluation may avoidmorbidity of extended/extensive surgical approaches.
참고문헌 (18)
- Zhang G, "Magnetic resonance imaging in categorization of ovarian epithelial cancer and survival analysis with focus on apparent diffusion coefficient value : correlation with Ki-67expression and serum cancer antigen-125 level", J Ovarian Res, 12, pp.59~ (2019)
- Timmermans M, "Interval between debulking surgery and adjuvant chemotherapy is associated with overall survival in patients with advanced ovarian cancer", Gynecol Oncol, 150, pp.446~450 (2018)
- Kumar A, "Risk-prediction model of severe postoperative complications after primary debulking surgery for advanced ovarian cancer", Gynecol Oncol, 140, pp.15~21 (2016)
- Aletti GD, "A new frontier for quality of care in gynecologic oncology surgery : multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model", Gynecol Oncol, 107, pp.99~106 (2007)
- Alphs HH, "Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer", Gynecol Oncol, 103, pp.1048~1053 (2006)
- Stuart GC, "2010 Gynecologic Cancer InterGroup(GCIG)consensus statement on clinical trials in ovarian cancer : report from the Fourth Ovarian Cancer Consensus Conference", Int J Gynecol Cancer, 21, pp.750~755 (2011)
- Chi DS, "What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma(EOC)?", Gynecol Oncol, 103, pp.559~564 (2006)
- Colombo PE, "Aggressive surgical strategies in advanced ovarian cancer : a monocentric study of 203 stage IIIC and IV patients", Eur J Surg Oncol, 35, pp.135~143 (2009)
- Harter P, "Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer", Gynecol Oncol, 121, pp.615~619 (2011)
- Bristow RE, "Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era : a meta-analysis", J Clin Oncol, 20, pp.1248~1259 (2002)
- Aletti GD, "Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer", Am J Obstet Gynecol, 197, pp.676~ (2007)
- Wright JD, "Defining the limits of radical cytoreductive surgery for ovarian cancer", Gynecol Oncol, 123, pp.467~473 (2011)
- Hofstetter G, "The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma-analysis of patient data in the prospective OVCAD study", Gynecol Oncol, 131, pp.15~20 (2013)
- Cloven NG, "Management of ovarian cancer in patients older than 80 years of age", Gynecol Oncol, 73, pp.137~139 (1999)
- Chéreau E, "Ovarian cancer in the elderly : impact of surgery on morbidity and survival", Eur J Surg Oncol, 37, pp.537~542 (2011)
- Fanfani F, "Elderly and very elderly advanced ovarian cancer patients : does the age influence the surgical management?", Eur J Surg Oncol, 38, pp.1204~1210 (2012)
- Langstraat C, "Morbidity, mortality and overall survival in elderly women undergoing primary surgical debulking for ovarian cancer : a delicate balance requiring individualization", Gynecol Oncol, 123, pp.187~191 (2011)
- Gerestein CG, "Causes of postoperative mortality after surgery for ovarian cancer", Eur J Cancer, 45, pp.2799~2803 (2009)