Factors associated with one-year mortality after debulking surgery in older women with ovarian cancer.

Abstract

e17069 Background: The objective of this study was to assess the factors associated with one-year mortality following cytoreductive surgery among women ≥65 years with epithelial ovarian cancer (EOC). Methods: Since 2011, patients aged 65 and older with advanced EOC, who underwent cytoreductive surgery within two months of initial visit, and had at least one year of follow up were included. Mortality data was retrieved from social security death index. Independent variables of interest were age, American Society of Anesthesiologist Physical Status (ASA-PS) classification, preoperative albumin, Memorial Sloan Kettering Frailty Index (MSK-FI), procedure time, intraoperative blood loss, 30-day minor and major adverse events, 30-day readmission and emergency room visits, stage, rate of suboptimal surgery, and receipt of neoadjuvant chemotherapy (NACT). Univariate analysis was performed to assess relationship between these variables and one-year mortality. Results: In total, 263 women (median age 70, range 65-88), of whom 26% had stage IV disease and 5% suboptimal surgery, were included. One-year mortality was 6.5% (n = 17), with six patients dying within six months. On univariate analysis, patients who died within the first year differed from those who were alive at one year in terms of length of stay (13 vs 9 days, p = 0.01), pre-operative albumin (3.8 vs 4.1, p = 0.01), major adverse events (29.4% vs. 12.2%, p = 0.04), and receipt of NACT (33.3% vs. 14.7%, p = 0.05). Patients who died within one year had an insignificant difference in MSK-FI (1.4 vs. 0.8, p = 0.08), and pre-operative hemoglobin (11.4 vs. 12.1, p = 0.06), as well as no difference in in age, ASA-PS, stage, procedure time, blood loss, minor adverse events, readmission and emergency room visits. Patients with suboptimal surgery did not have significantly higher one-year mortality rates, compared to those with optimal resection (11.8% vs. 4.5%, p = 0.5). Conclusions: Cytoreductive surgery in the selected group of older women is safe. In this cohort, age and ASA PS were not among factors associated with one year mortality. More robust risk stratification for this cohort is needed.