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ObjectiveComplication rates after cytoreductive surgery are important quality indicators for hospitals that treat patients with advanced-stage ovarian cancer. Case-mix factors are patient and tumor characteristics that may influence hospital outcomes such as the complication rates. Currently, no case-mix adjustment model exists for complications after cytoreductive surgery; therefore, it is unclear whether hospitals are being compared correctly. This study aims to develop the first case-mix adjustment model for complications after surgery for advanced-stage ovarian cancer, enabling an accurate comparison between hospitals.MethodsThis population-based study included all patients undergoing cytoreductive surgery for advanced-stage ovarian cancer registered in the Netherlands in 2017–2019. Case-mix variables were identified and assessed using logistic regressions. The primary outcome was the composite outcome measure ‘complicated course’. Patients had a complicated course when at least one of the following criteria were met: (1) any complication combined with a prolonged length of hospital stay; (2) complication requiring reintervention; (3) any complication with a prolonged length of stay in the intensive care unit; or (4) 30-day mortality or in-hospital mortality during admission following surgery. Inter-hospital variation was analyzed using univariable and multivariable logistic regressions and visualized using funnel plots.ResultsA total of 1822 patients were included, of which 10.7% (n=195) had a complicated course. Comorbidity and tumor stage had a significant impact on complicated course rates in multivariable logistic regression. Inter-hospital variation was not significant for case-mix factors. Complicated course rates ranged between 2.2% and 29.1%, and case-mix adjusted observed/expected ratios ranged from 0.20 to 2.67 between hospitals. Three hospitals performed outside the confidence intervals for complicated course rates. These hospitals remained outliers after case-mix adjustment.ConclusionThere is variation between hospitals regarding complicated course rates after cytoreductive surgery for ovarian cancer in the Netherlands. While comorbidity and tumor stage significantly affected the complicated course rates, adjusting for case-mix factors did not significantly affect hospital outcomes. The limited impact of case-mix adjustment could be a result of the Dutch centralized healthcare model.

Purpose of reviewMucinous ovarian cancers (MOCs) are categorized into infiltrative and expansile subtypes. These subtypes have different characteristics and prognoses. Patients with clinical early-stage disease of both subtypes currently undergo surgical staging (peritoneal washing, biopsies, omentectomy). Peritoneal and lymph node metastases of expansile MOC are rare, but whereas lymph node sampling (LNS) is omitted in these patients, peritoneal staging is not. Therefore, we collected all available MOC data to determine whether staging surgeries could safely be omitted in clinical early-stage expansile and infiltrative MOC. Recent findingsCurrent literature confirms that peritoneal metastases are rare in expansile MOC: more than 90% of patients have early-stage disease. Only 3.4% of the patients with clinical early-stage expansile MOC had positive peritoneal washings at surgical staging. Patients with infiltrative MOC were diagnosed more frequently with advanced-stage disease (21À54%). Moreover, upstaging clinical early-stage infiltrative MOC based on positive cytology, peritoneum and omentum metastases occurred in 10.3% of the patients. Therefore, we recommend that patients with early-stage infiltrative MOC undergo peritoneal staging and LNS. However, in addition to omitting LNS, we can also safely recommend omitting peritoneal staging in patients with clinical early stage expansile MOC.

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Introduction/Background* During COVID-19 pandemic many studies have been published; concerning oncological patients SARS-CoV2 infection is correlated to a 29.4% mortality rate. Few data describe the incidence and outcome of COVID-19 infection in patients undergoing chemotherapy.The aim of our study is to assess COVID-19 behavior in patients treated with chemotherapy. Methodology We considered 179 patients affected by gynecological cancers who underwent chemotherapy during the pandemic. Patients were educated to respect COVID-19 rules of conduct. We used different criteria to screen the patients with the rhino-pharyngeal swab and anamnestic questionnaire, so we analyzed two different periods: 11 th March-15 th October 2020, 16 th October 2020-30 th April 2021. From 11 th March to 30 th April 2020 we screened the symptomatic patients; from 1 st May to 15 th October 2020 the swab was made to all patients before their first access. Conversely, during the second period (16 th October 2020-30 th April 2021), we made the swab to all patients every 28 days. Patients resulted positive to COVID-19 were suspended from chemotherapy until their first negative swab. Result(s)* During the first period 806 chemotherapy cycles were carried out: there were no positive patients. During the second period 775 chemotherapy cycles were carried out: 13/ 99 (13.3%) patients resulted positive. Three of them (23.1%) were symptomatic; among these only one patient (7.7%) had SARS-CoV2 pneumonia and was admitted to semi-intensive care; what is important to underline is that this patient was positive before starting the second line chemotherapy. Two patients (15.4%) were paucisymptomatic, one of whom died for cancer progression. Overall, 10 patients (77%) resulted asymptomatic. Conclusion* Our experience supports that chemotherapy does not worsen SARS-CoV2 symptoms and mortality rate. Only with periodic swabs it was possible to identify positive patients, as they were asymptomatic. Moreover, none of the patients who became positive during chemotherapy developed pneumonia.Further studies are needed to evaluate the protective role of chemotherapy against COVID-19 symptoms and complications.

Objectives The OVHIPEC-1 trial demonstrated improved recurrence-free and overall survival with the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) in patients with stage III epithelial ovarian cancer (EOC). In 2019, HIPEC for this patient population was implemented in ten Dutch HIPEC-centers. This