Complications After Primary Cytoreduction for Advanced Ovarian Cancer
Posted: Tuesday, May 26, 2020
Ying Zhou, MD, PhD, and colleagues from the Anhui Provincial Hospital, Hefei, China, suggested that, due to postoperative complications, clinicians should be cautious when performing extensive cytoreduction surgery on patients with advanced epithelial ovarian cancer who have high American Society of Anesthesiologists (ASA) classification scores (more severe systemic disease). The researchers also stressed that the multidisciplinary teams responsible for patient care should have proper surgical training, experience, and an understanding of risk tolerance. The findings were originally slated for presentation at the 2020 NCCN Annual Conference (Abstract CLO20-069) and published in the JNCCN–Journal of the National Comprehensive Cancer Network.
Using the Clavien-Dindo Classification of Surgical Complications, the research team graded postoperative complications in 47 patients who underwent primary cytoreduction, including extra upper abdominal surgery, for stage IIIc and IV epithelial ovarian cancer. All patients were treated at the Anhui Provincial Hospital between September 2017 and March 2019. [The Clavien-Dindo classification is widely used to grade adverse events that occur as a result of surgical procedures. Grade I represents any deviation from the normal postoperative course not requiring surgical, endoscopic, or radiologic intervention and grade V is defined as patient death.]
Of the 47 patients who underwent surgery, 45 patients (95.7%) achieved optimal tumor reduction. Grade III to V complications were reported in 13 patients. Abnormal wound healing was recorded in 14.9% of patients and was the most frequently reported severe toxicity. No complications were reported for the seven patients who underwent diaphragmatic resection, including three cases with mesh repairment and two cases with right cardiophrenic angle lymph nodes. Among the patients who had a total colon resection, the research team reported two cases of anastomosis leakage, but both recovered with drainage and rinsing.
Overall, two patients died of infectious shock, and a single patient died of disseminated intravascular coagulation. The factors significantly associated with overall complications included high ASA scores (P = .03) and estimated blood loss (P = .01).
Disclosure: Dr. Zhou disclosed that her work on this project was supported by the National Natural Science Foundation of China and the Anhui Provincial Key Research and Development Program. The other study authors reported no conflicts of interest.
