Abstract
Introductionprediction and importance of severe postoperative complications after ovarian cancer surgery is a strong issue in patient selection and evaluation. Pre- and early peroperative predictors of severe 30-days postoperative complications (Clavien-Dindo class ≥3) after surgery for primary ovarian cancer are not fully established, neither their impact on patients’ survival. Materials and methodsA prospective observational study included 256 patients with primary ovarian cancer FIGO stages IIB-IV, operated during 2009–2018 in a primary or interval debulking surgery setting. Patient variables were analysed in relation to severe postoperative complications (Clavien-Dindo class ≥3) and overall survival. ResultsHigh-grade postoperative complications occurred in 24.2% patients. Class 3a complications were observed in 12.5% cases. High-grade complications class ≥3 were observed in 31.6% after primary debulking surgery compared to 12.2% after interval debulking surgery (p = 0.0004). Peritoneal cancer index ≥21 and preoperative albumin concentration ≤33 g/L were independent predictors of high-grade complications. Peritoneal cancer index correlated with the surgical complexity score and completeness of cytoreduction. Increased peritoneal cancer index was a negative predictor of overall survival, but high-grade complications did not influence survival negatively. ConclusionsPeritoneal cancer index ≥21 was an independent predictor of high-grade complications after ovarian cancer surgery. Increased peritoneal cancer index also impacted overall survival negatively, but high-grade complications did not influence overall survival.
Highlights
Complete cytoreduction is the aim of ovarian cancer surgery, and an important predictor of survival [1,2]
After adjustment for age, body-mass index (BMI), platelet count, Federation of Gynecology and Obstetrics (FIGO) stage, Primary debulking surgery (PDS) or interval debulking surgery (IDS) and completeness of cytoreduction, hazard ratio (HR) for increasing age was 1.02 and HR for peritoneal cancer index (PCI) was 1.05
Our findings suggest that PCI !21 and albumin concentration 33 g/L define patients with increased risk for high-grade postoperative complications, half of which comprise Clavien-Dindo class 3b and higher
Summary
Complete cytoreduction is the aim of ovarian cancer surgery, and an important predictor of survival [1,2]. Primary debulking surgery (PDS) is the standard of care for operable patients with resectable International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IV disease, followed by platinum-based chemotherapy [3,4]. Two randomized clinical trials suggested that interval debulking surgery (IDS) following neoadjuvant chemotherapy was not inferior to PDS [5,6], the rate of complete cytoreduction in those studies was low [2]. The peritoneal cancer index (PCI) is a measure of the extent of peritoneal carcinosis [10,11]. PCI is widely used during the evaluation of the extent of colorectal carcinosis and prediction of surgical complexity [12].
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
