Multi-Center Evaluation of Post-Operative Morbidity and Mortality after Optimal Cytoreductive Surgery for Advanced Ovarian Cancer

Abstract

PurposeWhile optimal cytoreduction is the standard of care for advanced ovarian cancer, the related post-operative morbidity has not been clearly documented outside pioneering centers. Indeed most of the studies are monocentric with inclusions over several years inducing heterogeneity in techniques and goals of surgery. We assessed the morbidity of optimal cytoreduction surgery for advanced ovarian cancer within a short inclusion period in 6 referral centers dedicated to achieve complete cytoreduction.Patients and MethodsThe 30 last optimal debulking surgeries of 6 cancer centers were included. Inclusion criteria included: stage IIIc- IV ovarian cancer and optimal surgery performed at the site of inclusion. All post-operative complications within 30 days of surgery were recorded and graded using the Memorial secondary events grading system. Student-t, Chi2 and non-parametric statistical tests were performed.Results180 patients were included. There was no demographic differences between the centers. 63 patients underwent surgery including intestinal resections (58 recto-sigmoid resection), 24 diaphragmatic resections, 17 splenectomies. 61 patients presented complications; One patient died post-operatively. Major (grade 3–5) complications requiring subsequent surgeries occurred in 21 patients (11.5%). 76% of patients with a major complication had undergone an ultraradical surgery (P = 0.004).ConclusionWhile ultraradical surgery may result in complete resection of peritoneal disease in advanced ovarian cancer, the associated complication rate is not negligible. Patients should be carefully evaluated and the timing of their surgery optimized in order to avoid major complications.

Serum CA 125 Level after Neoadjuvant Chemotherapy is Predictive of Prognosis and Debulking Surgery Outcomes in Advanced Epithelial Ovarian Cancer

“…The prognosis of ovarian cancer is related to cytoreduction, which represents one of the most important treatment factors related to surgery and may even be important in cases of recurrent disease 12,13 . Quality of life, efficacy of subsequent chemotherapy, and median survival each depend on residual tumor volume after cytoreductive surgery 14,15 .…”

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

“…However, postoperative complications after aggressive tumor debulking, including radical retroperitoneal lymphadenectomy, are very common, increasing the hospitalization time, while also affecting the quality of life of the patients [5]. Of those complications, symptomatic lymphocele (SLC) is an important problem in over 35% of patients [6,7].…”

Predictive Factors for Surgical Morbidities and Adjuvant Chemotherapy Delay for Advanced Ovarian Cancer Patients Treated by Primary Debulking Surgery or Interval Debulking Surgery

“…17,18 Because IDS are usually less aggressive than PDS, they have lower rates of postoperative complications. 13,18 In addition, they have higher rates of complete tumor resection. 8,18 Postoperative complications are commonly observed in cytoreductive surgeries.…”