Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis

Malika Kengsakul*, Gatske M. Nieuwenhuyzen-De Boer, Suwasin Udomkarnjananun, Stephen J. Kerr, Christa D. Niehot, Heleen J. van Beekhuizen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective: Advances in ovarian cancer cytoreductive surgery have enabled more extensive procedures to achieve maximal cytoreduction but with a consequent increase in postoperative morbidity and mortality. The aim of this study was to evaluate factors for postoperative morbidity after extensive cytoreductive surgery for primary epithelial ovarian cancer (EOC), particularly those which may be modifiable. Methods: Electronic databases were searched. Meta-analysis was conducted using random-effects models. Results: Fifteen relevant studies, involving 15,325 ovarian cancer patients, were included in this review. Severe 30-day postoperative complications occurred in 2,357 (15.4%) patients. The postoperative mortality rate was 1.92%. Meta-analysis demonstrated that patient with following risk factors; age (p<0.001), Eastern Cooperative Oncology Group score >0 (p=0.001), albumin level <3.5 g/dL (p<0.001), presence of ascites on CT scan (p=0.013), stage IV disease (p<0.001) and extensive surgical procedure (p<0.001) has a significantly increase risk of developing postoperative complications. Surgical procedures including peritonectomy (p=0.012), splenectomy (p<0.001) and colon surgery (p<0.001) were significant predictors for postoperative complications. Moreover, we found that patients who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) had a lower risk of developing severe complications compared to those who underwent primary debulking surgery (PDS) (p<0.001). Conclusion: Our study demonstrated that patient performance status and hypoalbuminemia were the only significant adjustable preoperative risk factors associated with postoperative complications. Patients who underwent NACT-IDS had a lower risk of developing severe complications compared to PDS. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42021282770.

Original languageEnglish
Article numbere53
JournalJournal of Gynecologic Oncology
Volume33
Issue number4
Early online date7 Jun 2022
DOIs
Publication statusPublished - Jul 2022

Bibliographical note

Funding Information:
The authors would like to thank the collaborators of the Medical Library of the Erasmus Medical Center, Rotterdam for their help of the systematic literature search.

Publisher Copyright:
© 2022. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.

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