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Abstract
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.
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.