Postoperative outcomes of primary and interval cytoreductive surgery for advanced ovarian cancer registered in the Dutch Gynecological Oncology Audit (DGOA)

Tewarie, Nishita Baldewpersad; Driel, Willemien J. van; Ham, Maaike van; Wouters, Michel W.J.M.; Kruitwagen, Roy F.P.M.; Kruse, Arnold‐Jan; Yigit, Refika; Aa, M. van der; Mens, J.W.; Stam, T.; Diepstraten, Jeroen; Kolk, A. Van Der; Verhoeve, Harold R.; Smedts, H.P.M.; Jong, A.M.L.D. Van Haaften-de; Reesink, N.; Vos, MC; Cate, A.D. Ten; Slangen, Brigitte; Timmers, Petra; Smit, R.A.; Gaarenstroom, K.N.; Vencken, P.M.L.H.; Engelen, M.J.A.; Verbruggen, M.B.; Boll, Dorry; Briët, Justine M.; Fons, Guus; Coppus, S.F.P.J.; Baalbergen, Astrid; Dorst, E.B.L. van; Tjiong, Ming Y.; Roes, Eva Maria; Visschers, B.A.J.T.; Gerestein, C.G.; Nagel, H.T.C.; Aalders, Anette L.; Hofman, Laura; Lange, J.G.; Ebisch, I.M.W.; Waard, Judith de; Plas-Koning, Y.W.C.M. van der; Huisman, Margriet A.

doi:10.1016/j.ygyno.2021.05.030

Cited by 14 publications

(8 citation statements)

References 16 publications

(24 reference statements)

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“…In addition, patients with FIGO stage III had an increased risk for a complicated course in the current study. Initially, the explanation for this result was that patients with FIGO stage III more frequently underwent primary surgery compared with patients with FIGO stage IV, and patients undergoing primary surgery are known to have increased risks of certain complications 14 15. However, in the current analysis, primary surgery was not significantly associated with complicated course in multivariable analysis.…”

Section: Discussionmentioning

confidence: 54%

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Case-mix adjustment to compare hospital performances regarding complications after cytoreductive surgery for ovarian cancer: a nationwide population-based study

Algera

Tewarie

Driel

et al. 2022

Int J Gynecol Cancer

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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.

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Section: Discussionmentioning

confidence: 54%

“…The type of surgery was additionally included as a variable in the model since data from a prior study showed that patients are known to have a complicated course more frequently after primary compared with interval cytoreductive surgery 14. Moreover, neoadjuvant chemotherapy may reduce the risk of certain post-operative complications 15.…”

Section: Methodsmentioning

confidence: 99%

Case-mix adjustment to compare hospital performances regarding complications after cytoreductive surgery for ovarian cancer: a nationwide population-based study

Algera

Tewarie

Driel

et al. 2022

Int J Gynecol Cancer

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“…During the past decade, several strategies designed to improve surgical outcomes in patients with gynecological malignancies have been implemented [ 14 ]. An enhanced recovery after surgery (ERAS) protocol was developed and recommended in an international guideline for management of gynecological malignancy [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Predicting 30-Day Grade IIIa–V Clavien–Dindo Classification Complications and Delayed Chemotherapy Initiation after Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: A Prospective Cohort Study

Kengsakul

Boer

Udomkarnjananun

et al. 2022

Cancers

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Objective: The aim of this study was to evaluate factors associated with 30-day postoperative Clavien–Dindo classification (CDC) grade IIIa or greater complications and delayed initiation of chemotherapy after cytoreductive surgery (CRS) for primary advanced-stage epithelial ovarian cancer (AEOC). Methods: This was a prospective study involving 300 patients who underwent primary or interval CRS for AEOC between February 2018 and September 2020. Postoperative complications were graded according to the CDC. Logistic regression analysis was used to evaluate factors predicting CDC grade ≥IIIa and time to chemotherapy (TTC) >42 days. Results: Interval CRS was performed in 255 (85%) patients. CDC grade ≥IIIa occurred in 51 (17%) patients. In multivariable analysis, age (p = 0.036), cardiovascular comorbidity (p < 0.001), diaphragmatic surgery (p < 0.001), intraoperative urinary tract injury (p = 0.017), and upper-abdominal visceral injury (e.g., pancreas, stomach, liver, or spleen) (p = 0.012) were associated with CDC grade ≥IIIa. In 26% of cases, TTC was >42 days (median (IQR) 39 (29–50) days) in patients with CDC grade ≥IIIa versus 33 (25–41) days in patients without CDC grade ≥ IIIa (p = 0.008). The adjusted odds ratio of developing TTC >42 days was significantly higher in patients associated with WHO performance grade ≥2 (p = 0.045), intraoperative bowel injury (p = 0.043), upper-abdominal visceral injury (p = 0.008), and postoperative CDC grade ≥IIIa (p = 0.032). Conclusions: Patients with advanced age, with cardiovascular comorbidity, and who required diaphragmatic surgery had an increased adjusted odds ratio of developing CDC grade ≥IIIa complications. CDC grade ≥IIIa complications were independently associated with TTC >42 days. Proper patient selection and prevention of intraoperative injury are essential in order to prevent postoperative complications and delayed initiation of chemotherapy.

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“…Furthermore, receipt of chemotherapy was similar among women with and without postoperative complications in the retrospective review by Zhaomin Xu et al (20). However, in the dutch gynaecological oncology audit (DGOA), it was apparent that the higher percentage of complications resulted in a prolonged time to start adjuvant chemotherapy (21). In contrast to this study, the retrospective population-based study in the United States by Joseph A. Dottino et.al, showed that in matched primary and interval cytoreductive surgery cohorts, ultra-radical surgery was associated with the increased likelihood of post-operative complications and use of acute care services.…”

Section: Discussionmentioning

confidence: 98%

Ultra-radical surgery for advanced ovarian cancer: a retrospective cohort study in a tertiary referral cancer center in the UK

Palaiologos

Nikoloudaki

Adedipe

et al. 2023

Minerva Obstet Gynecol

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BackgroundOvarian cancer is the leading cause of death from gynaecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and e cacy of this extensive surgery. ObjectiveThe aim of this study is to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our ndings with the current literature. MethodsThis is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate. ResultsThe study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease free survival time was 2.9 years while median disease free survival time was 2 years. Age (p=0.028) and complete cytoreduction (p=0.048) were found to be signi cantly associated with survival. Primary debulking surgery was signi cantly associated with lower probability of recurrence (p=0.049). ConclusionAlthough the number of patients is relatively small, our study indicates that ultra-radical surgery in centres with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited Gynaecological Oncologist and a Hepatobiliary General Surgeon with a special interest in ovarian cancer. A few cases required input from a Colorectal and a Thoracic Surgeon. We believe that the careful selection of the patients that can bene t from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to Page 3/18 establish that ultra-radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.

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Postoperative outcomes of primary and interval cytoreductive surgery for advanced ovarian cancer registered in the Dutch Gynecological Oncology Audit (DGOA)

Cited by 14 publications

References 16 publications

Case-mix adjustment to compare hospital performances regarding complications after cytoreductive surgery for ovarian cancer: a nationwide population-based study

Case-mix adjustment to compare hospital performances regarding complications after cytoreductive surgery for ovarian cancer: a nationwide population-based study

Factors Predicting 30-Day Grade IIIa–V Clavien–Dindo Classification Complications and Delayed Chemotherapy Initiation after Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: A Prospective Cohort Study

Ultra-radical surgery for advanced ovarian cancer: a retrospective cohort study in a tertiary referral cancer center in the UK

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