Objectives In the United States, trends in the initial treatment approach for ovarian cancer reflect a shift in paradigm toward the increased use of neoadjuvant chemotherapy and interval cytoreductive surgery. The aim of this study was to evaluate the trends in surgical cytoreductive procedures in ovarian cancer patients who underwent either primary or interval cytoreductive surgery.
Methods This retrospective, population-based study examined patients with stage III/IV ovarian cancer diagnosed between January 2000 and December 2013 identified using SEER-Medicare. Small or large bowel resection, ostomy creation, and upper abdominal procedures were identified using relevant billing codes and compared over time. A 1:1 primary and interval cytoreductive propensity matched cohort was created using demographic and clinical variables. 30-day complications and the use of acute care services were compared.
Results A total of 5417 women were identified. 34% underwent bowel resections, 16% ostomy creation, and 8% upper abdominal procedures. There was an increase in bowel resections and upper abdominal procedures from 2000 to 2013 in patients who underwent primary cytoreductive surgery. Compared with patients who received primary cytoreduction, patients who underwent interval cytoreductive surgery were less likely to undergo bowel resection (OR=0.50; 95% CI [0.41, 0.61]) or ostomy creation (OR=0.48; 95% CI [0.42, 0.56]). Upper abdominal procedures did not differ between groups. For patients who underwent primary cytoreductive surgery, these procedures were associated with intensive care unit stay (4.6% vs <2%, P<0.01). In both primary and interval cytoreductive surgery patients, the receipt of bowel and upper abdominal procedures was associated with multiple 30-day postoperative complications and higher rates of readmission and emergency room visits.
Conclusions The performance of upper abdominal procedures in ovarian cancer patients increased from 2000 to 2013. Interval cytoreductive surgery was associated with decreased likelihood of bowel surgery. In matched primary and interval cytoreductive surgery cohorts, the receipt of these procedures were associated with the increased likelihood of postoperative complications and use of acute care services.
- ovarian cancer
- postoperative complications
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Presented at Version of this abstract was presented at the Society for Gynecologic Oncology on March 24–27, 2018 in New Orleans, LA.
Contributors JD, CCS, and LM: conceptualization, methodology, data curation. WH, HZ, and SF: methodology, formal analysis, data curation, visualization. JD: writing – original draft preparation. SG, KL, and LM: supervision. JD, WH, CCS, HZ, SF, JRH, RS, SG, KL, and LM: writing – review and editing. All authors reviewed, discussed, and approved the edited final version of the manuscript.
Funding This work was supported by the T32 training grant for training of academic gynecologic oncologists T32-CA101642 (Dottino, Suidan), NIH-NCI grant K07-CA201013 (Meyer), NIH-NCI grant K08-CA234333 (Rauh-Hain) and the MD Anderson Cancer Center Support Grant P30-CA016672.
Competing interests LAM: received research funding from AstraZeneca for unrelated research, and has participated in an advisory board for Clovis Oncology in 2016. CCS: received research funding from AstraZeneca for unrelated research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.