Sonali Patankar1, William M Burke2, June Y Hou2, Ana I Tergas3, Yongmei Huang1, Cande V Ananth4, Alfred I Neugut5, Dawn L Hershman5, Jason D Wright6. 1. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA. 2. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA. 3. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA. 4. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA. 5. Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA. 6. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA. Electronic address: jw2459@columbia.edu.
Abstract
OBJECTIVE: Cytoreduction for ovarian cancer is associated with substantial morbidity. We examined the outcome of patients undergoing surgery for ovarian cancer to determine if there are sub-groups of patients who may benefit from alternative treatments. METHODS: The National Surgical Quality Improvement Program database was used to identify women who underwent surgery for ovarian cancer from 2005-2012. Multivariable logistic regression models were used to examine the effect of age, race, functional status, ASA class, preoperative albumin and performance of extended cytoreductive procedures on morbidity, mortality and resource utilization. RESULTS: A total of 2870 women were identified. The perioperative complication rate increased from 9.5% in women <50years, to 13.4% in those age 60-69years, and 14.6% in women ≥70years (P<0.0001). Similarly, complications rose from 7.3% in those who did not require any extended procedures to 12.9% after 1 procedure, 28.4% for those who had 2, and 30.0% in women who underwent ≥3 extended procedures (P<0.0001). In a series of multivariable models, the number of extended cytoreductive procedures performed and preoperative albumin were the factors most consistently associated with morbidity. Using a series of model fit statistics, compared to chance alone, the ability to predict any complication increased by 27.4% when procedure score was analyzed, 22.0% with preoperative albumin, 11% with age, and 4% with functional status. CONCLUSIONS: While preoperative clinical and demographic factors may help predict the risk of adverse outcomes for women undergoing surgery for ovarian cancer, performance of extended cytoreductive procedures is the strongest risk factor for complications.
OBJECTIVE: Cytoreduction for ovarian cancer is associated with substantial morbidity. We examined the outcome of patients undergoing surgery for ovarian cancer to determine if there are sub-groups of patients who may benefit from alternative treatments. METHODS: The National Surgical Quality Improvement Program database was used to identify women who underwent surgery for ovarian cancer from 2005-2012. Multivariable logistic regression models were used to examine the effect of age, race, functional status, ASA class, preoperative albumin and performance of extended cytoreductive procedures on morbidity, mortality and resource utilization. RESULTS: A total of 2870 women were identified. The perioperative complication rate increased from 9.5% in women <50years, to 13.4% in those age 60-69years, and 14.6% in women ≥70years (P<0.0001). Similarly, complications rose from 7.3% in those who did not require any extended procedures to 12.9% after 1 procedure, 28.4% for those who had 2, and 30.0% in women who underwent ≥3 extended procedures (P<0.0001). In a series of multivariable models, the number of extended cytoreductive procedures performed and preoperative albumin were the factors most consistently associated with morbidity. Using a series of model fit statistics, compared to chance alone, the ability to predict any complication increased by 27.4% when procedure score was analyzed, 22.0% with preoperative albumin, 11% with age, and 4% with functional status. CONCLUSIONS: While preoperative clinical and demographic factors may help predict the risk of adverse outcomes for women undergoing surgery for ovarian cancer, performance of extended cytoreductive procedures is the strongest risk factor for complications.
Authors: Jason D Wright; Cande V Ananth; Jennifer Tsui; Sherry A Glied; William M Burke; Yu-Shiang Lu; Alfred I Neugut; Thomas J Herzog; Dawn L Hershman Journal: Cancer Date: 2014-01-17 Impact factor: 6.860
Authors: Robert E Bristow; Rafael S Tomacruz; Deborah K Armstrong; Edward L Trimble; F J Montz Journal: J Clin Oncol Date: 2002-03-01 Impact factor: 44.544
Authors: Robert F Ozols; Brian N Bundy; Benjamin E Greer; Jeffrey M Fowler; Daniel Clarke-Pearson; Robert A Burger; Robert S Mannel; Koen DeGeest; Ellen M Hartenbach; Rebecca Baergen Journal: J Clin Oncol Date: 2003-07-14 Impact factor: 44.544
Authors: W J Hoskins; W P McGuire; M F Brady; H D Homesley; W T Creasman; M Berman; H Ball; J S Berek Journal: Am J Obstet Gynecol Date: 1994-04 Impact factor: 8.661
Authors: Dennis S Chi; Corinna C Franklin; Douglas A Levine; Faina Akselrod; Paul Sabbatini; William R Jarnagin; Ronald DeMatteo; Elizabeth A Poynor; Nadeem R Abu-Rustum; Richard R Barakat Journal: Gynecol Oncol Date: 2004-09 Impact factor: 5.482
Authors: Rudy S Suidan; Pedro T Ramirez; Debra M Sarasohn; Jerrold B Teitcher; Svetlana Mironov; Revathy B Iyer; Qin Zhou; Alexia Iasonos; Harold Paul; Masayoshi Hosaka; Carol A Aghajanian; Mario M Leitao; Ginger J Gardner; Nadeem R Abu-Rustum; Yukio Sonoda; Douglas A Levine; Hedvig Hricak; Dennis S Chi Journal: Gynecol Oncol Date: 2014-07-11 Impact factor: 5.482
Authors: Stephanie Cham; Ling Chen; Caryn M St Clair; June Y Hou; Ana I Tergas; Alexander Melamed; Cande V Ananth; Alfred I Neugut; Dawn L Hershman; Jason D Wright Journal: Am J Obstet Gynecol Date: 2019-02-13 Impact factor: 8.661
Authors: Ashley L Cole; Emma L Barber; Anagha Gogate; Arthur-Quan Tran; Stephanie B Wheeler Journal: Int J Gynecol Cancer Date: 2018-07 Impact factor: 3.437
Authors: Stefano Cianci; Vito Andrea Capozzi; Andrea Rosati; Valerio Rumolo; Giacomo Corrado; Stefano Uccella; Salvatore Gueli Alletti; Matteo Riccò; Anna Fagotti; Giovanni Scambia; Francesco Cosentino Journal: Front Med (Lausanne) Date: 2022-04-25
Authors: Alli M Straubhar; Jennifer L Wolf; Ms Qin C Zhou; Alexia Iasonos; Stephanie Cham; Jason D Wright; Kara Long Roche; Dennis S Chi; Oliver Zivanovic Journal: Gynecol Oncol Date: 2020-12-04 Impact factor: 5.482