Introduction/Background Surgical complications following primary (PDS) or interval debulking surgery (IDS) for advanced ovarian cancer can impact patients’ quality of life and survival. Postoperative complications at our institution were investigated and associations with patient characteristics and surgical outcomes were explored.
Methodology Women with stage III/IV ovarian cancer who underwent PDS or IDS at the European Institute of Oncology, Milan, between 2009 and 2021 were included. Patient characteristics, surgical outcomes, and postoperative complications were retrieved from medical records. Complications were graded based on the Accordion Severity Classification System. Univariate and multivariate regression analysis was performed using Accordion ≥ III as endpoint and pre-/intra-operative factors as predictors.
Results The study included 1213 patients with a mean age at diagnosis of 58.9 (SD=10.7). Among them, 90.7% (n=1100) were high-grade serous, and 53.9% (n=654) underwent PDS. Accordion complications class ≥ III were registered in 278 (22.9%) patients; seven deaths (0.6%) occurred during the first 30 days. A total of 104 (8.6%) patients required drainage under local anesthesia for pleural effusion, which was the most frequent class III complication. Anastomosis-related complications requiring surgical revisions were the most frequent class IV (n=40, 3.3%) and V (n=5, 0.4%). In univariate analysis, BMI >25kg/m2, ASA score >2, FIGO stage IV, PDS, an intermediate/high SCS, preoperative albumin, intraoperative blood loss, and surgical time were significantly associated with severe complications. In multivariate analysis, only a high SCS [OR=5.18 (95% CI: 1.05–25.69)] and intraoperative blood loss [OR=1.06 (95% CI: 1.00–1.12)] remained statistically significant.
Conclusion The risk factors for severe complications identified in our study should be considered in the surgical planning for patients with advanced ovarian cancer. Minimizing postoperative morbidity and improving processes of care is of paramount importance for patients’ survival and quality of life, in addition to avoiding delay in chemotherapy initiation.
Disclosures The authors have no conflicts of interest to declare.
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