Introduction/Background*The most significant prognostic factors in AOC are platinum sensitivity and residual disease following cytoreductive surgery. In order to achieve complete (R0) cytoreduction advanced surgical procedures may be required, so called ultraradical (UR) surgery. Such a change from traditional pelvic centred surgery to abdominal and thoracic wide surgery increases operative time. We aimed to evaluate the change in operative time (OT) following the establishment of a maximum effort treatment paradigm.
Methodology We performed a retrospective study looking at all stage 3/4 epithelial ovarian, tubal and peritoneal cancers operated on between 2014 and 2020 inclusive in one Cancer Centre in the UK. 198 patients were looked at with two patients excluded for missing variables. Surgical complexity was classified by the surgical complexity score as advocated by Aletti. OT was measured in minutes. Continuous variables were expressed as mean and standard deviation. Categorical variables were analysed using chi-squared testing. Groups were compared using one-way ANOVA.
Result(s)*A total of 196 were included. Results identified increasing year-on-year OT (2014; 192 ± 88 vs. 2020; 426 ± 121, p<0.0001). In latter years, OT plateaued (2018; 366 ± 131 vs. 2020; 426 ± 121, p>0.05). During this time period the R0 rate increased from 61% to 96%, p=0.001, achieved by more UR procedures, which increased from 13% to 71%, p<0.0001 and intermediate/high complexity surgery from 34% to 86%, p=0.0003. In 2014, when more standard procedures were being performed, mean OT was approximately 3 hours, excluding anaesthetic time (2014; mean OT 192+/- 88). As UR Surgeries increased to >50% of overall number of surgeries for advanced disease, the mean OT was a full operating day (2018; 367 ± 132, 2019; 375 ± 153 and 2020; 426 ± 122). Further increases in UR rates had less impact on OT (F(3,62)=1.11, p>0.05).
Conclusion*Effectively treating AOC patients requires appropriate theatre resources. We recommend that the standard of care for cytoreductive surgeries operated with maximal effort should be that only case is performed on that day. Funding and resource allocation for ovarian cancer surgery in the United Kingdom needs to reflect the greater theatre utilisation needed for these patients.
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