When we open and close: Postoperative outcomes after aborted primary cytoreduction for ovarian cancer

• Published in: Gynecologic oncology reports 2022-06, Vol.41, p.100981, Article 100981
• Main Authors: Wang, Connor C., Wagar, Matthew K., Godecker, Amy, Al-Niaimi, Ahmed, Kushner, David M.
• Format: Article
• Language: English
• Subjects: Aborted debulking; Aborted primary cytoreductive surgery; Epithelial ovarian cancer; Open and close surgery; Postoperative outcomes; Research Report
• ISSN: 2352-5789; 2352-5789
• DOI: 10.1016/j.gore.2022.100981

•Over one-third of patients experienced a grade 3 or higher surgical complication within 30 days after aborted surgery.•All patients who had aborted primary debulking went on to receive neoadjuvant chemotherapy and interval debulking.•After interval debulking, 97.6% achieved optimal debulking (48.8%-complete resection; 48.8% ≤1cm of residual disease). Little data exists to adequately counsel patients on the postsurgical morbidity and outcomes of an aborted primary debulking (AD) for advance stage epithelial ovarian cancer. Our objectives were to examine the 30-day morbidity of AD, percentage of patients who subsequently undergo neoadjuvant chemotherapy (NACT) and interval cytoreductive surgery (ICS), residual disease at ICS, and predictors for complications after AD. This was a single-institution retrospective analysis of patients who underwent AD for ovarian cancer from 01/2008 to 12/2020 using ICD-10 diagnoses and procedure codes. Patient demographics, perioperative metrics, and residual disease at ICS were collected. Thirty-day postoperative complications were graded by the Common Terminology Criteria for Adverse Events. Fisher’s exact tests compared categorical and Wilcoxon rank-sum tests compared continuous variables. Logistic regression provided unadjusted odds ratios to identify predictors for post-AD complications. Forty-eight patients underwent AD, and 43 were included for analysis. All had at least stage IIIC high grade serous ovarian cancer. All patients subsequently underwent ICS, with 21 (48.8%) achieving no residual macroscopic disease and 21 (48.8%) to ≤ 1 cm of macroscopic disease. After AD, 16 (37.2%) experienced at least one G ≥ 3 event within the first 30 days. The most common complication was gastrointestinal complications. Preoperative albumin was the only significant predictor for G ≥ 3 complication after AD. Approximately one-third of patients will experience at least one G ≥ 3 complications after AD. Complications may be anticipated by low preoperative albumin. Patients can be counseled that, after AD, proceeding to subsequent NACT and ICS and achieving optimal debulking is common.