Introduction/Background*Complete cytoreduction is the cornerstone of the treatment for ovarian cancer (OC). Patients are triaged either for primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), based on the preoperative assessment. The aim of this study is to evaluate the impact of the enhanced recovery after surgery (ERAS) protocol in postoperative morbidity for both groups (PDS vs. IDS).
Methodology Retrospective analysis of women with OC from the 1st Department of Obstetrics & Gynecology AUTh at ‘Papageorgiou’ Hospital (ESGO Certified Center for AOC), 2017 – 2019. Patients were triaged for PDS or IDS based on preoperative imaging and ‘laparoscopic Fagotti’s score’. Patient & tumor characteristics, treatment options and follow-up information were collected. Primary outcomes were ICU admittance, post-operative complications (Clavien – Dindo classification) and duration of hospitalization.
Result(s)*78 patients met the inclusion criteria: 40 underwent PDS and 38 IDS. The two groups had no significant difference in patients characteristics (age, Charlson comorbidity index (CCI)). Furthermore, concerning surgical outcomes PDS vs IDS group had higher surgical complexity score (SCS), blood loss and complete debulking rate, but with no statistical significance (5 vs. 4, p=0.1466/350 vs. 300, p=0.1197/77.5% vs. 68.4%, p=0.5958 respectively). Only the duration of the surgery was statistically significant in the PDS group (300 vs. 195 min, p = 0.007). The implementation of the ERAS protocol led to comparable results with no statistical significance for postoperative morbidity, between the two groups: The PDS group had higher ICU admittance (17.5% vs. 2.6%, p=0.9741), lower overall complications (15 vs. 19, p=0.9741) and the same hospitalization (8 ± 3 vs. 8 ± 2.8 days, p=0.3805).
Conclusion*Careful preoperative selection of patients and the implementation of the ERAS program in the management of OC results in comparable postoperative morbidity between PDS and IDS, regardless of the higher SCS in the upfront surgery or the toxicity of the NACT. Further prospective studies are needed to validate these results.
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