Amanika Kumar1, Jo Marie Janco1, Andrea Mariani1, Jamie N Bakkum-Gamez1, Carrie L Langstraat1, Amy L Weaver2, Michaela E McGree2, William A Cliby3. 1. Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. 2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States. 3. Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: cliby.william@mayo.edu.
Abstract
OBJECTIVES: To refine models to predict surgical morbidity and 90-day mortality after primary debulking surgery (PDS) for advanced epithelial ovarian cancer (EOC). METHODS: Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, and vital status were abstracted. Complications were graded using the Accordion classification. Nomograms were generated based on multivariate modeling. RESULTS: 138 (22.3%) of the 620 patients who underwent PDS experienced a grade≥3 complication. Age (OR 1.21 per 10 years increase in age), BMI (OR 1.35 for BMI<25 kg/m2 versus reference, OR 2.83 for BMI≥40 kg/m2 versus reference), ASA score≥3 (OR 1.49), stage (OR 1.69 stage IV) and surgical complexity (OR 2.32 high complexity versus intermediate) were predictive of an accordion grade≥3 complication Within 90 days of surgery, 55 (8.9%) patients died. A multivariable model included age (OR 1.76 per 10 year increase in age), ASA score≥3 (OR 3.28), preoperative albumin<3.5 (OR 4.31), and BMI (OR 2.04 for BMI<25 kg/m2 versus reference, OR 3.64 for BMI≥ 40 kg/m2 versus reference) was predictive of 90-day mortality. CONCLUSION: Using an independent cohort we report the importance of age, ASA score, preoperative albumin, FIGO stage, and surgical complexity, and BMI, to refine a prediction model for complications after PDS for advanced EOC. This information is useful in preoperative counseling and can be utilized to aid in patient-centered decision making and risk stratification.
OBJECTIVES: To refine models to predict surgical morbidity and 90-day mortality after primary debulking surgery (PDS) for advanced epithelial ovarian cancer (EOC). METHODS:Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, and vital status were abstracted. Complications were graded using the Accordion classification. Nomograms were generated based on multivariate modeling. RESULTS: 138 (22.3%) of the 620 patients who underwent PDS experienced a grade≥3 complication. Age (OR 1.21 per 10 years increase in age), BMI (OR 1.35 for BMI<25 kg/m2 versus reference, OR 2.83 for BMI≥40 kg/m2 versus reference), ASA score≥3 (OR 1.49), stage (OR 1.69 stage IV) and surgical complexity (OR 2.32 high complexity versus intermediate) were predictive of an accordion grade≥3 complication Within 90 days of surgery, 55 (8.9%) patients died. A multivariable model included age (OR 1.76 per 10 year increase in age), ASA score≥3 (OR 3.28), preoperative albumin<3.5 (OR 4.31), and BMI (OR 2.04 for BMI<25 kg/m2 versus reference, OR 3.64 for BMI≥ 40 kg/m2 versus reference) was predictive of 90-day mortality. CONCLUSION: Using an independent cohort we report the importance of age, ASA score, preoperative albumin, FIGO stage, and surgical complexity, and BMI, to refine a prediction model for complications after PDS for advanced EOC. This information is useful in preoperative counseling and can be utilized to aid in patient-centered decision making and risk stratification.
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: Diogo Torres; Chen Wang; Amanika Kumar; Jamie N Bakkum-Gamez; Amy L Weaver; Michaela E McGree; Gottfried E Konecny; Ellen L Goode; William A Cliby Journal: Gynecol Oncol Date: 2018-06-18 Impact factor: 5.482
Authors: Alexi A Wright; Kari Bohlke; Deborah K Armstrong; Michael A Bookman; William A Cliby; Robert L Coleman; Don S Dizon; Joseph J Kash; Larissa A Meyer; Kathleen N Moore; Alexander B Olawaiye; Jessica Oldham; Ritu Salani; Dee Sparacio; William P Tew; Ignace Vergote; Mitchell I Edelson Journal: Gynecol Oncol Date: 2016-08-08 Impact factor: 5.482
Authors: Alexi A Wright; Kari Bohlke; Deborah K Armstrong; Michael A Bookman; William A Cliby; Robert L Coleman; Don S Dizon; Joseph J Kash; Larissa A Meyer; Kathleen N Moore; Alexander B Olawaiye; Jessica Oldham; Ritu Salani; Dee Sparacio; William P Tew; Ignace Vergote; Mitchell I Edelson Journal: J Clin Oncol Date: 2016-08-08 Impact factor: 44.544
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
Authors: Deepa M Narasimhulu; Aneesa Thannickal; Amanika Kumar; Amy L Weaver; Michaela E McGree; Carrie L Langstraat; William A Cliby Journal: Gynecol Oncol Date: 2020-12-31 Impact factor: 5.482