Predictive model for major complications after extensive abdominal surgery in primary advanced ovarian cancer
Received 11 October 2018
Accepted for publication 12 December 2018
Published 7 March 2019 Volume 2019:11 Pages 161—167
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Dr Everett Magann
Antoni Llueca,1–3 Anna Serra,1–3 Karina Maiocchi,2,4 Katty Delgado,2,5 Rosa Jativa,2,6 Luis Gomez,2,4 Javier Escrig3–5
On behalf of the MUAPOS working group (Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery)
1Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain; 2Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain; 3Department of Medicine, University Jaume I (UJI), Castellon, Spain; 4Department of General Surgery, University General Hospital of Castellon, Castellon, Spain; 5Department of Radiology, 6Department of Anaesthesiology, University General Hospital of Castellon, Castellon, Spain
Background: Surgery for advanced ovarian cancer (AOC) frequently results in serious complications. The present study aimed to determine the importance of various factors and complications in cytoreductive surgery for AOC.
Patients and methods: The present study included 90 patients with AOC who underwent primary cytoreductive surgery in a single institution from January 2013 to August 2017. Demographic and clinicopathologic characteristics, surgical procedures, residual disease, and follow-up data were analyzed. Cytoreductive surgery was defined as complete (no residual tumor), optimal (residual tumor 1 cm in diameter). Grade III–IV complications were considered major. Patients were evaluated every 3–6 months.
Results: Surgical outcome was complete in 75 (82%), optimal in 5 (6%), and suboptimal in 11 (12%) patients. Major complications occurred in 28 (31%) patients. Independent risk factors for major complications were ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. A score created by weighing the multivariate OR for each risk factor correctly predicted major complications in 67% of cases. A score cut-off of >2 discriminated between patients with and without complications in 79% of cases (95% CI: 70%–86%, P<0.001). Adjuvant chemotherapy was performed as planned in 67 patients (74%), including 50 (75%) without major complications and 17 (25%) with major complications.
Conclusion: Risk factors for major complications in cytoreductive surgery for AOC are ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. Our model predicts morbidity based on major and minor classifications of complications.
Keywords: advanced ovarian cancer, debulking surgery, peritoneal cancer index, residual tumor, complications, predictive model, carcinomatosis, cytoreductive surgery, morbidity
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