Complications from Surgeries Related to Ovarian Cancer Screening

Abstract

The aim of this study was to evaluate complications of surgical intervention for participants in the Kentucky Ovarian Cancer Screening Program and compare results to those of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. A retrospective database review included 657 patients who underwent surgery for a positive screen in the Kentucky Ovarian Cancer Screening Program from 1988–2014. Data were abstracted from operative reports, discharge summaries, and office notes for 406 patients. Another 142 patients with incomplete records were interviewed by phone. Complete information was available for 548 patients. Complications were graded using the Clavien–Dindo (C–D) Classification of Surgical Complications and considered minor if assigned Grade I (any deviation from normal course, minor medications) or Grade II (other pharmacological treatment, blood transfusion). C–D Grade III complications (those requiring surgical, endoscopic, or radiologic intervention) and C–D Grade IV complications (those which are life threatening) were considered “major”. Statistical analysis was performed using SAS 9.4 software. Complications were documented in 54/548 (10%) subjects. For women with malignancy, 17/90 (19%) had complications compared to 37/458 (8%) with benign pathology (p < 0.003). For non-cancer surgery, obesity was associated with increased complications (p = 0.0028). Fifty patients had minor complications classified as C–D Grade II or less. Three of 4 patients with Grade IV complications had malignancy (p < 0.0004). In the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, 212 women had surgery for ovarian malignancy, and 95 had at least one complication (45%). Of the 1080 women with non-cancer surgery, 163 had at least one complication (15%). Compared to the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, the Kentucky Ovarian Cancer Screening Program had significantly fewer complications from both cancer and non-cancer surgery (p < 0.0001 and p = 0.002, respectively). Complications resulting from surgery performed as a result of the Kentucky Ovarian Cancer Screening Program were infrequent and significantly fewer than reported in the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. Complications were mostly minor (93%) and were more common in cancer versus non-cancer surgery.

Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting

“…In the 2006 Agency for Healthcare Research and Quality "Management of Adnexal Mass" document (47), there were three deaths among 1500 surgeries for adnexal masses. Morbidity from surgery for benign adnexal cysts includes fever, urinary tract infection, urinary retention, bladder injury, wound infection, and cardiovascular and/or pulmonary complications with the incidence of complications ranging from 3.1% to 15% in screening trials (68,71,73).…”

“…Because a simple cyst is likely benign, the group consensus was to obtain the initial follow-up study in a range from 3-12 months, using a 3-6-month time frame if providers and/or patients had concerns regarding potential cyst mischaracterization or if this cyst has a high likelihood of resolving (as is the case for premenopausal women). O-RADS uses a time frame for repeat study of 2-3 months for premenopausal women (73), and that is certainly reasonable for short-interval follow-up if patient or physician anxiety leads to a request for an earlier study to document resolution. Therefore, in premenopausal women we set a lower limit for follow-up of 2 months.…”

Ovarian Cancer Screening: Lessons about Effectiveness

“…They report that complications resulting from surgery performed in the Kentucky Ovarian Cancer Screening Program were infrequent and significantly fewer than reported in the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. Complications observed were mostly minor (93%) and were more common in cancer versus non-cancer surgery [ 8 ].…”