Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies

Donato, Violante Di; Kontopantelis, Evangelos; Aletti, Giovanni; Casorelli, Assunta; Piacenti, Ilaria; Bogani, Giorgio; Lecce, Francesca; Panici, Pierluigi Benedetti

doi:10.1245/s10434-016-5680-7

Cited by 31 publications

(20 citation statements)

References 62 publications

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“…Most models have used single institutional data to determine factors associated with short term morbidity and mortality and have included factors, such as age, ASA score, surgical complexity and tumor characteristics, such as stage, grade, and histology. [18][19][20][21][22][23][24] The objective of our study was to use a large, national dataset to determine factors associated with short-term, significant perioperative morbidity and mortality and to create a nomogram to predict the risk of adverse perioperative outcomes. Using this nomogram, we hope to create a prediction tool for patients who are being considered for primary debulking or neoadjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a risk-calculator for adverse perioperative outcomes for women with ovarian cancer

Cham

Chen

Clair

et al. 2019

American Journal of Obstetrics and Gynecology

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Background-Primary cytoreduction followed by platinum based chemotherapy is the primary treatment for advanced ovarian cancer. However neoadjuvant chemotherapy followed by interval debulking is an alternative option, particularly in those who may be poor surgical candidates.Objective-The objective of this study was to determine factors associated with short term, significant perioperative morbidity and mortality for women undergoing surgery for ovarian cancer and to create a nomogram to predict the risk of adverse perioperative outcomes.Study Design-We used the National Surgical Quality Improvement Program database to identify women with ovarian, fallopian tube, or primary peritoneal cancer who underwent surgery from 2011-2015. Demographic factors, clinical characteristics, comorbidity, functional status and the extent of surgery were used to predict the risk of severe perioperative complications or death using multivariable models. Multiple imputation methods were employed for missing data. A nomogram was developed based on the final model. The discrimination ability of the model was assessed with a calibration plot and discrimination C-index.Results-We identified a total of 7,029 patients. Overall, 5.8% of patients experienced a Clavien-Dindo IV complication, 9.8% of patients were readmitted, 3.0% of patients required a reoperation,

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Section: Introductionmentioning

confidence: 99%

Development and validation of a risk-calculator for adverse perioperative outcomes for women with ovarian cancer

Cham

Chen

Clair

et al. 2019

American Journal of Obstetrics and Gynecology

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“…There is substantial toxicity associated with aggressive primary cytoreduction in older patients, particularly those over the age of 75. In a recent systematic review, both increased age and disease stage were strong predictors of 30-day mortality 25 . The authors found that the estimated 30-day mortality for primary cytoreduction was 4.6%.…”

Section: Gynecological Cancermentioning

confidence: 99%

Recent advances in cancer surgery in older patients

Rostoft

Audisio

2017

F1000Res

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Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations. The importance of incorporating frailty assessment into the preoperative evaluation of older surgical patients has received increasing attention over the last 10 years. Furthermore, studies that include endpoints such as functional status, cognitive status, and quality of life beyond the standard endpoints, i.e. postoperative morbidity and mortality, are starting to emerge. This review looks at recent evidence regarding geriatric assessment and frailty in older surgical cancer patients and provides a summary of newer studies in colorectal, liver, pancreatic, and gynecological cancer and renal and central nervous system tumors.

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“…The mean age of living donors from the first 45 uterine transplantation cases was 45.4 years [48]. Retrieval surgery can be likened to a radical hysterectomy, a procedure more routinely performed among much older patients (median age 65 years) undergoing debulking for ovarian malignancy [66]. Therefore, it should be emphasised that women undergoing uterine transplantation are much younger, with reduced pre‐anaesthetic medical comorbidity.…”

Section: Anaesthetic Considerations During Fertility‐sparing Surgerymentioning

confidence: 99%

Anaesthetic considerations for fertility‐sparing surgery and uterine transplantation

et al. 2021

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Summary A number of benign and malignant gynaecological conditions can cause infertility. Advancements in assisted reproductive technologies have facilitated the rapidly evolving subspecialty of fertility preservation. Regardless of clinical indication, women now have the reproductive autonomy to make fully informed decisions regarding their future fertility. In particular, there has been an increasing interest and demand among patients and healthcare professionals for fertility‐sparing surgery. Gynaecologists find themselves continually adapting surgical techniques and introducing novel procedures to facilitate this rapidly emerging field and anaesthetists need to manage the consequent physiological demands intra‐operatively. Not only is it important to understand the surgical procedures now undertaken, but also the intra‐operative management in an ever evolving field. This article reviews the methods of fertility‐sparing surgery and also describes important anaesthetic challenges including peri‐operative care for women undergoing complex fertility‐sparing surgeries such as uterus transplantation.

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Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies

Abstract: Metaregression demonstrated that increased age and advanced clinical stage were independently associated with an increased risk of mortality, and the combined effects of both factors greatly increased the risk.

Cited by 31 publications

References 62 publications

Development and validation of a risk-calculator for adverse perioperative outcomes for women with ovarian cancer

Development and validation of a risk-calculator for adverse perioperative outcomes for women with ovarian cancer

Recent advances in cancer surgery in older patients

Anaesthetic considerations for fertility‐sparing surgery and uterine transplantation

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