Role of predictive markers for severe postoperative complications in gynecological cancer surgery: a prospective study (RISC-Gyn Trial)

Abstract

BackgroundSurgery for gynecological cancer involves highly invasive and complex procedures potentially associated with various complications, which can cause extended hospital stays and delay of subsequent therapy, with a detrimental effect on the prognosis. The aim of this study was to explore and define the predictors of severe postoperative complications in patients undergoing surgery for gynecologic cancer.MethodsPatients undergoing surgery for gynecologic cancers were analyzed prospectively from October 2015 through January 2017. Using validated assessment tools preoperatively, we assessed comorbidities, performance status, quality of life, nutritional and body composition by bioelectrical impedance analysis, and the surgical data of each patient. Surgical complications were graded using the Clavien-Dindo criteria. Using stepwise logistic regression models, we identified predictive markers for postoperative complications.ResultsOf the 226 enrolled patients, 40 (17.7%) experienced a grade ≥IIIb complication according to the Clavien-Dindo criteria. In the regression analysis, overweight/obesity (body mass index >25) (OR 6.41, 95% CI 2.38 to 17.24; p<0.001) and impaired physical functioning defined by a quality of life questionnaire (OR 4.19, 95% CI 1.84 to 9.50; p=0.001) emerged as significant predictors of postoperative complications. Moreover, postoperative complications were predicted by phase angle of bioelectrical impedance analysis <4.75° (OR 3.11, 95% CI 1.35 to 7.16; p=0.008) and Eastern Cooperative Oncology Group (ECOG) performance status >1 (OR 2.51, 95% CI 1.06 to 5.92; p=0.04). Intraoperative factors associated with higher risk of postoperative complications were increased use of norepinephrine (>11 µg/kg/min) (OR 5.59, 95% CI 2.16 to 14.44; p<0.001) and performance of large bowel resection (OR 4.28, 95% CI 1.67 to 10.97; p=0.002).ConclusionIn patients undergoing surgery for gynecological cancer, preoperative evaluation of performance status according to ECOG, domains of quality of life and nutritional status, as well as intraoperative monitoring of risk factors, might help to identify patients at high risk for severe postoperative complications, and thus reduce surgical morbidity and mortality.

Low preoperative skeletal muscle density is predictive for negative postoperative outcomes in older women with ovarian cancer

“…Candidate predictors identified from previous research in patients with ovarian cancer were: age, BMI, polypharmacy, ASA classification, comorbidity, functional impairment, and FIGO stage. [23][24][25][26] Other predictors we hypothesized that could be relevant were: preoperative living situation, fall risk, pre-existing memory problems, history of confusion during illness, malnutrition, use of a walking aid, tumor grade and bowel surgery performed (as indicator of surgical complexity).…”

Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HR-QoL) in Patients with Ovarian Cancer: What Is Different Compared to Healthy Women?

“…In our previous publications, we demonstrated that restrictions in QoL domains such as physical functioning had a significant effect on the risk of severe postoperative complications [ 11 , 12 ]. Furthermore, we found that patients with debilitating symptoms and cognitive impairment had an increased risk of developing severe postoperative complications [ 11 ].…”

“…This work is a subgroup analysis of the data from a prospective study ”Role of Predictive Markers for Severe Postoperative Complications in Gynecological Cancer Surgery” (RISC-GYN Trial) [ 12 ]. The study was designed to identify predictors for severe postoperative complications in patients with gynecological cancer.…”

“…Furthermore, we classified the patients from the RISC-Gyn Trial [ 12 ] into two groups: age <65 and ≥65 years, and then looked for differences in their HR-QoL according to the EORTC QLQ-C30. The groups were compared using a T-Test.…”

“…Previous works demonstrated a strong association between the physical part of the EORTC QLQ-C30 and severe postoperative complications [ 11 , 12 , 13 ]. In particular, functioning domains such as low physical ability and some specific symptoms, most notably, pain, fatigue, and loss of appetite, were associated with poorer survival in cancer patients [ 14 ].…”