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Significance of Perioperative Infection in Survival of Patients With Ovarian Cancer
  1. Koji Matsuo, MD*,
  2. Christina P. Prather, MD,
  3. Edward H. Ahn, MD,
  4. Michele L. Eno, MD§,
  5. Katherine E. Tierney, MD*,
  6. Annie A. Yessaian, MD*,
  7. Dwight D. Im, MD,
  8. Neil B. Rosenshein, MD and
  9. Lynda D. Roman, MD*
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles County Medical Center, Los Angeles, CA;
  2. Department of Internal Medicine, University of North Carolina, Chapel Hill, NC;
  3. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA;
  4. §Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; and
  5. The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD.
  1. Address correspondence and reprint requests to Koji Matsuo, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles County Medical Center, 2020 Zonal Ave, IRD520, Los Angeles, CA 90031. E-mail:


Objectives Perioperative infectious diseases comprise some of the most common causes of surgical mortality in women with ovarian cancer. This study was aimed to evaluate the significance of perioperative infections in survival of patients with ovarian cancer.

Methods Patients who underwent primary cytoreductive surgery were included in the analysis (n = 276). The enumeration and speciation of pathogens, antimicrobial agents used, and sensitivity assay results were culled from medical records and correlated to clinicopathologic demographics and survival outcomes. Perioperative infection was determined as a positive microbiology result obtained within a 6-week postoperative period.

Results The incidence of perioperative infection was 15.9% (common sites: urinary tract, 57.3%, and surgical wound, 21.4%). Commonly isolated pathogens were Enterococcus species (22.4%) and Escherichia coli (19.4%) in urinary tract infection, and Bacteroides fragilis, E. coli, and Klebsiella pneumoniae (all, 16%) in surgical wound infection. Imipenem represents one of the least resistant antimicrobial agents commonly seen in urinary tract and surgical wound infections in our institution. Perioperative infection was associated with diabetes, serous histology, lymph node metastasis, bowel resection, decreased bicarbonate, and elevated serum urea nitrogen in multivariate analysis. Perioperative infections were associated with increased surgical mortality, delay in chemotherapy treatment, decreased chemotherapy response, shorter progression-free survival (median time, 8.4 vs 17.6 months; P < 0.001), and decreased overall survival (29.0 vs 51.8 months; P = 0.011). Multivariate analysis showed that perioperative infections other than urinary tract infection remained a significant risk factor for decreased survival (progression-free survival, P = 0.02; and overall survival, P = 0.019).

Conclusion Perioperative infectious disease comprises an independent risk factor for survival of patients with ovarian cancer.

  • Ovarian cancer
  • Perioperative infection
  • Surgical mortality
  • Survival
  • Prediction

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  • The authors declare that there is no conflict of interest.

  • Part of data were presented at the 42nd Annual Meeting of Society of Gynecologic Oncologists (SGO), Orlando, FL, March 6–9, 2011.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (