Effects of ascites on perioperative and postoperative outcome in epithelial ovarian cancer

Abstract

e16567 Background: A third of epithelial ovarian cancer (EOC) patients (pts) present with ascites at the time of diagnosis. Though not universally accepted, ascites has been reported to be a poor prognostic factor. Our purpose is to study the effects of ascites on the peri and postoperative outcome in EOC patients undergoing cytoreductive surgery. Methods: 172 EOC pts were retrospectively evaluated to determine the prognostic significance of ascites. Pts were divided into two groups based on the presence of ascites defined in pre-operative CT scans as A, none/small, versus B, moderate/ large. Influence of ascites on peri- and post-operative characteristics such as estimated blood loss (EBL), rates of optimal cytoreduction, intensive care unit (ICU) admission, minor complications (infection, ileus/bowel obstruction, transfusion, wound separation, DVT/PE), major complications (death or readmission within 30 days) and length of hospital stay (LOS) were analyzed using Chi Square, multivariate linear and cox regression, where appropriate. Results: There was no significant difference in EBL between the two groups (p = 0.27). Pts in A were more likely to be optimally cytoreduced compared to B (96% vs 61%, p < 0.001). After controlling for stage, women in B were more likely to be admitted to the ICU, (OR 3.03 (95% CI: 1.05–8.71). The rates of major complication was higher for B (3% vs 10%) though this did not reach statistical significance (p = 0.06). Overall minor complications were greater for B than in A (64% vs 26%, p < 0.0001). After controlling for stage, LOS was 2.9 days longer in B (p = 0.02). 21 women received at least 3 cycles of neoadjuvant chemotherapy prior to cytoreduction. EBL, LOS and major complications were no different than those undergoing primary cytoreduction then adjuvant chemotherapy. Conclusions: Optimal management of EOC pts with ascites is uncertain. Pts with ascites are more likely to be suboptimally cytoreduced, have increased rates of complications and consume more healthcare resources (ICU admission and longer LOS). Though our numbers are small, patients who received neoadjuvant chemotherapy do not have any difference in peri-post operative characteristics, but were all optimally cytoreduced. No significant financial relationships to disclose.