Article Text

Download PDFPDF

#454 Proposition of a tailored perioperative-care algorithm for patients with advanced-stage ovarian cancer, based on the surgical complexity score (aletti score)
  1. Elisa Scarpelli1,2,
  2. Lucie Longuepée-Bourdon3,1,
  3. Camille Godart4,
  4. Aurelie Lafanechere4,
  5. Maxime Riquet4,
  6. Mathilde Duchatelet1,
  7. Matthieu De Codt5,
  8. Manon Lefebvre1,
  9. Carlos Martinez-Gomez1,
  10. Fabrice Narducci1 and
  11. Delphine Hudry1
  1. 1Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France, Lille, France
  2. 2Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy, Parma, Italy
  3. 3Medicine faculty, Henri Warembourg, Lille University, Lille, France
  4. 4Department of Anesthesiology, Centre Oscar Lambret, Lille, France, Lille, France
  5. 5Department of Gynecology, University Hospital of Namur-Godinne, Namur, Belgium, Lille, France


Introduction/Background Advanced ovarian cancer (AOC) treatment requires extensive surgical procedures. The reported frequency of complications following cytoreductive surgery (CRS) ranges from 10 to 20%. Depending on the number of surgical gestures performed, the Surgical Complexity Score (SCS) defines three levels of complexity, low (≤3), intermediate (4–7), and high (≥8), associated with incremental postoperative morbidity.

Methodology At our institution, all patients undergo a staging laparoscopy to assess disease extension. If eligibility for CRS is established, definitive surgery is planned in 7–14 days. We analyzed the CRS complication rate according to the SCS in 239 patients, between 2017 and 2022. CRS performed was classified as low risk for 35 patients (14.6%), intermediate risk for 110 patients (46%), and high risk for 94 patients (39.3%). Within 30 days after surgery, the severe post-operative complication rate was 10%. Among patients with SCS < 8, the risk of complication was 7.6% versus 13.8% with SCS ≥ 8 (OR=1.96 [0.84- 4.57]). With a multidisciplinary team, we developed a tailored perioperative care algorithm based on presumed SCS at staging laparoscopy, and actual SCS at laparotomy.

Results Preoperative care (bowel preparation, oral supplementation) is proposed according to estimated SCS. When CRS is performed, the early postoperative period management is based on actual SCS. If SCS<8, the nasoenteric tube is removed at the end of the surgery, and no drain is placed. If SCS≥8, a nasoenteric tube is placed for enteral nutrition, and observation in an intensive care unit is proposed. For this group of patients, a short-term postoperative examination and lab tests are systematically planned 15–20 days after discharge, and then after 1 month.

Abstract #454 Figure 1

Perioperative-care algorithm for patients with advanced-stage ovarian cancer based on the Surgical Complexity Score (Aletti score)

Conclusion SCS resumes surgical complexity and individuates higher-risk patients. Our algorithm aims to increase adherence to evidence-based recommendations, and mostly, in the era of precision medicine, it aims to implement a patient-focused care plan.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.