Prediction of 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer

Gerestein, C.G.; Nieuwenhuyzen-de Boer, G.M.; Eijkemans, M.J.; Kooi, G.S.; Burger, C.W.

doi:10.1016/j.ejca.2009.10.017

« Previous Next »European Journal of Cancer
Volume 46, Issue 1 , Pages 102-109, January 2010

Prediction of 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer

C.G. Gerestein
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel Den Hoed/Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Corresponding author: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus MC/Daniel Den Hoed University Oncology Center, Groene Hilledijk 301, 3075 AE Rotterdam, The Netherlands. Tel.: +31 10 7041263; fax: +31 10 4391986.
G.M. Nieuwenhuyzen-de Boer
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
M.J. Eijkemans
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
G.S. Kooi
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
C.W. Burger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daniel Den Hoed/Erasmus MC University Medical Center, Rotterdam, The Netherlands

Received 19 June 2009; received in revised form 8 October 2009; accepted 15 October 2009. published online 09 November 2009.

Abstract

Objective

Treatment in advanced stage epithelial ovarian cancer (EOC) is based on primary cytoreductive surgery followed by platinum-based chemotherapy. Successful cytoreduction to minimal residual tumour burden is the most important determinant of prognosis. However, extensive surgical procedures to achieve maximal debulking are inevitably associated with postoperative morbidity and mortality. The objective of this study is to determine predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC.

Methods

All patients in the South Western part of the Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007 were identified from the Rotterdam Cancer Registry database. All peri- and postoperative complications within 30days after surgery were registered and classified according to the definitions of the National Surgical Quality Improvement Programme (NSQIP).

To investigate independent predictors of 30-day morbidity, a Cox proportional hazards model with backward stepwise elimination was utilised. The identified predictors were entered into a nomogram.

Results

Two hundred and ninety-three patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. 30-day morbidity was seen in 99 (34%) patients. Postoperative morbidity could be predicted by age (P=0.007; odds ratio [OR] 1.034), WHO performance status (P=0.046; OR 1.757), extent of surgery (P=0.1308; OR=2.101), and operative time (P=0.017; OR 1.007) with an optimism corrected c-statistic of 0.68.

Conclusion

30-day morbidity could be predicted by age, WHO performance status, operative time and extent of surgery. The generated nomogram could be valuable for predicting operative risk in the individual patient.

Keywords: Ovarian cancer, Cytoreductive surgery, 30-Day morbidity, Postoperative mortality, Surgical complications