Introduction/Background This study aimed to evaluate the postoperative complications and their impacts on patients who have undergone primary surgery (including extensive upper abdominal surgery) of ovarian epithelial cancer with the enhanced recovery programme.
Methodology We identified all patients with stage I∼IV ovarian carcinoma who underwent primary surgery in our centre. Postoperative complications were evaluated and graded according to the Clavien–Dindo Classification.
Results Among 161 patients, 46 cases (28.57%) were performed with surgical staging, 27(16.77%) with standard cytoreduction, 12(7.45%) with en-bloc debulking, and 76(47.20%) with extraradical debulking; 157 patients (97.52%) achieved optimal tumour reduction (<1 cm). The mean postoperative hospitalisation time was 17.33±11.29 days after completion of initial postoperative chemotherapy (IPC), and the interval of IPC was 16.22±10.09 days. Thirteen patients (8.07%) had grade 3 complications (9 wound dehiscence, 3 digestive tract leakage, and 1 bladder fistula). Two patients (1.24%) had grade 4–5 complications (1 severe pneumonia infection and back to intensive care unit [ICU] for tracheotomy and respiration rehabilitation; 1 died of septicaemia on day 19). As for preoperative factors analysis, multivariate analysis revealed that HE4 ≥717 pM (P = 0.015) and Federation International of Gynecology and Obstetrics (FIGO) IV stage (P = 0.004, compared with IIIC stage) were associated with grade 3∼5 complications. Bootstrap analysis found CA125 ≥1012 U/mL (P = 0.034), HE4 ≥717 pM (P = 0.007), and FIGO IV stage (P = 0.002, compared with IIIC stage) had statistical significance. As for postoperative factors analysis, multivariate analysis did not reveal the risk factors associated with grade 3∼5 complications; bootstrap analysis only found that transfer to ICU after surgery (P=0.026) had statistical significance.
Conclusion Application of enhanced recovery after surgery protocols in epithelial ovarian carcinoma are useful and support the early initiation of chemotherapy and a short hospitalisation time, and it is safe for primary extensive radical cytoreduction with low mortality 1/76 (1.31%).
Disclosures This study was funded by the National Natural Science Foundation of China (81872110, 81902632), National Key R&D Program of China (2018YFC1003900), the Anhui Provincial Innovative Program for Organ Transplantation (S20183400001), and Anhui Provincial Key Research and Development Program (1704a0802151). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare that they have no competing interests.
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