Preoperative quality of life as prediction for severe postoperative complications in gynecological cancer surgery: results of a prospective study

Abstract

Purpose The aim of this study was to investigate preoperative quality of life (QoL) as a predictive tool for severe postoperative complications (POC) in gynecological cancer surgery. Methods This is a prospective study of patients undergoing gynecologic cancer surgery at an academic center in Germany. QoL was assessed by the EORTC Quality of Life Questionnaire (QLQ-C30) and the NCCN Distress Thermometer (DT). Several geriatric assessment tools have been applied. POC were graded using Clavien–Dindo criteria. Using multivariable logistic regression models, we identified predictive clinical characteristics for postoperative complications. Results Within 30 days of surgery, 40 patients (18%) experienced grade ≥ 3b complications including 9 patients (4%) who died. The dominant complication was anastomosis insufficiency with 13 patients (5.8%). In the multivariable stepwise logistic regression through all univariate significant variables, we found that impaired physical functioning was predictive of POC, defined by an EORTC score < 70 (OR 5.08, 95% CI 2.23–11.59, p < 0.001). Regarding symptoms nausea/vomiting assessed as an EORTC score > 20 (OR 3.08, 95% CI 1.15–8.26, p = 0.025) indicated a significant predictive value. Being overweight or obese (BMI > 25) were also identified as predictive factors (OR 5.44, 95% CI 2.04–14.49, p = 0.001) as were reduced Mini Mental State Examination (MMSE) results < 27 (OR 7.94, 95% CI 1.36–45.46, p = 0.02). Conclusion Preoperative QoL measurements could help to predict postoperative complications in patients with gynecological cancer. Patients with limitations of mobility, debilitating symptoms and cognitive impairment have an increased risk for developing severe POC.

ECOG and BMI as preoperative risk factors for severe postoperative complications in ovarian cancer patients: results of a prospective study (RISC-GYN—trial)

“…Several publications focusing on ovarian cancer showed obesity as a highly predictive factor for postoperative complications [10,[26][27][28][29][30][31][32]. Extreme BMIs-both high and low, have been found to be associated with severe postoperative complications [10].…”

Platelet-rich plasma (PRP) in oncological patients: long-term oncological outcome analysis of the treatment of subcutaneous venous access device scars in 89 breast cancer patients

“…The high patient satisfaction should be weighed against the low cost of $50 for each ACP ® double syringe system. It is important to consider that improving quality of life may counteract cancer-related cognitive impairment for cancer survivors [ 17 , 18 ]. The use of PRP should at least be considered and offered to patients.…”

Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HR-QoL) in Patients with Ovarian Cancer: What Is Different Compared to Healthy Women?

“…In our previous publications, we demonstrated that restrictions in QoL domains such as physical functioning had a significant effect on the risk of severe postoperative complications [ 11 , 12 ]. Furthermore, we found that patients with debilitating symptoms and cognitive impairment had an increased risk of developing severe postoperative complications [ 11 ]. Further work in our institution showed that objective and self-reported cognitive functioning, together with appetite loss, were prognostic for mortality in elderly cancer patients [ 26 ].…”

“…Previous works demonstrated a strong association between the physical part of the EORTC QLQ-C30 and severe postoperative complications [ 11 , 12 , 13 ]. In particular, functioning domains such as low physical ability and some specific symptoms, most notably, pain, fatigue, and loss of appetite, were associated with poorer survival in cancer patients [ 14 ].…”