Age-Associated Risk of 90-Day Postoperative Mortality After Cytoreductive Surgery for Advanced Ovarian Cancer

Abstract

Using cluster analysis, when participants were divided into 2 groups based on the change in irisin, those with greater change experienced a greater decrease in BMI at 6 months. The Δ change in irisin from baseline to 12 months was associated with changes in IL-6 (r = 0.674, P = .01). The change in myostatin from baseline to 6 months or 12 months was not associated with changes in BMI, HOMA-IR, irisin, or IL-6. Discussion | Our study provides, for the first time to our knowledge, evidence of an association between myokines and bariatric surgery in youths with severe obesity. The changes in irisin and myostatin suggest that the postsurgical improvements in cardiometabolic health may be associated, partly, with these novel muscle-derived mediators. Increase in irisin may suggest induction of fat browning and combustion. 1 The postsurgical decrease in myostatin may reflect a counteractive adaptation to preserve muscle mass. 3 Identification of 2 distinct groups of participants with varying magnitudes of changes in irisin and myostatin using cluster analysis, despite the small sample size, is intriguing and may suggest potential heterogeneity in Roux-en-Y gastric bypass response. This needs further validation in larger samples. Studies in adults are sparse and contradictory, with levels of irisin decreasing after bariatric surgery in 1 study and remaining unchanged in another. 4,5 It remains unclear whether the postsurgical changes in myokines are secondary to weight loss or owing to the bariatric surgery itself. Postsurgical decrease in myostatin we found is similar to that in adults. 6 Limitations of the study include small sample size, inclusion of only female youths, and lack of racial/ethnic diversity, DXA-derived body composition, and values of the myokines in healthy control individuals. This study implicates myokines in the beneficial effects of bariatric surgery, but further validation in diverse cohorts is warranted. Modulation of signaling pathways of the myokines may have a potential role in the treatment of severe obesity and cardiometabolic disease.

New strategies in ovarian cancer treatment

“…This has defined an area of unmet need regarding how to provide for the frail and frail elderly appropriately so that they may participate in state-of-the-art trials. 38 The addition of changes in eligibility and the recognition of these important subsets of patients with unmet needs, coupled with new strategies and clinical trial designs, will advance opportunities, safety, and outcomes for women with ovarian cancer.…”

Surgical risk assessment for gynecological oncologic patients

“…As a consequence, postoperative morbidity, mortality, and healthcare costs can be reduced through the prevention of postoperative complications. Previous studies have depicted that several parameters such as age, advanced stage, poor performance, ascites ≥1000, hypoalbuminemia, extended surgical time, and extensive surgery were associated with a higher risk of postoperative complications (4,5,6,22,23,24,25,26,27) . There are several studies about surgical risk assessment.…”

Expanding Medicaid Improves Outcomes in Gynecologic Malignancies, But is it Enough?

“…Patients age 65 years or older were excluded from the study population due to eligibility for Medicare. However, this Medicare-eligible population accounts for a significant proportion of postoperative mortality, 4 and its omission from the analysis may partially explain the paradoxical lack of improvement in ovarian cancer postoperative mortality. Patients with ovarian cancer in this age group (40-64 years) may be more likely to represent those with cancer related to genetic mutations, 5 which may represent an overall healthier population with lower morbidity and mortality.…”