An analysis of the influence of infection on overall survival rates, following modified posterior pelvic exenteration for advanced ovarian cancer
Abstract
Objectives: The aim of our study was to determine the association between the appearance of infection after modified posterior pelvic exenteration (MPE) and the time to adjuvant chemotherapy (TTC), and to examine whether infection has any impact on clinical results by delaying the start of chemotherapy.
Material and methods: Our retrospective study analyzed 77 patients who had undergone MPE followed by adjuvant
chemotherapy. Postoperatively, either there was no residual tumor or, the residual tumor was less than 2.5 mm, in 76.7% of the study patients. Our study group was divided into two subgroups for comparison; the first group consisted of 41 patients with postoperative infections, and the second group of 36 patients had no infections. The infections of the first group were monitored during a 90-day postoperative period. Median TTC and overall survival rates (OS) were determined for those patients who developed an infection as well as for those who did not.
Results: The expected 5-year survival rate was 0.40 (SD = 0.09) for those patients without infection and 0.17 (SD = 0.07) for those patients with infection. The survival curves of patients with infection and those without infection were significantly different statistically (p = 0.038). The median TTC differed significantly for those patients who developed infection compared with those patients who did not develop infection (37 days compared with 27.5 days respectively, p = 0.024); and patients without infection were statistically more likely to receive chemotherapy within 25 days following surgery than in the subsequent 25–42-day period compared with those patients who did develop infection (p = 0.048). No statistically significant differences were found between the two groups in relation to results following the initiation of chemotherapy during the first 42 days postoperatively (p = 0.445).
Conclusions: The absence of postoperative infection was associated with better survival rates. Patients with infection
experienced a longer time interval between surgery and the start of chemotherapy, without negative impact to their
overall survival rates.
Keywords: advanced ovarian canceroverall survivalperioperative infectionstime to chemotherapy
References
- Katsumata N, Yasuda M, Takahashi F, et al. Japanese Gynecologic Oncology Group. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009; 374(9698): 1331–1338.
- Möbus V, Jackisch C, Lück HJ, et al. Cisplatin/paclitaxel vs carboplatin/paclitaxel: Optimizing of treatment in advanced ovarian cancer. European Journal of Cancer. 1997; 33: S119.
- Neijt JP, Engelholm SA, Tuxen MK, et al. Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. J Clin Oncol. 2000; 18(17): 3084–3092.
- Ozols RF, Bundy BN, Greer BE, et al. Gynecologic Oncology Group. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2003; 21(17): 3194–3200.
- Oza AM, Cook AD, Pfisterer J, et al. ICON7 trial investigators. Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): overall survival results of a phase 3 randomised trial. Lancet Oncol. 2015; 16(8): 928–936.
- Seagle BLL, Butler SK, Strohl AE, et al. Chemotherapy delay after primary debulking surgery for ovarian cancer. Gynecol Oncol. 2017; 144(2): 260–265.
- Hofstetter G, Concin N, Braicu I, et al. The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma - analysis of patient data in the prospective OVCAD study. Gynecol Oncol. 2013; 131(1): 15–20.
- Wright JD, Herzog TJ, Neugut AI, et al. Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer. Obstet Gynecol. 2012; 120(4): 871–881.
- Alexander M, Blum R, Burbury K, et al. Timely initiation of chemotherapy: a systematic literature review of six priority cancers - results and recommendations for clinical practice. Intern Med J. 2017; 47(1): 16–34.
- Liu Y, Yonemura Y, Levine EA, et al. BIG-RENAPE Group. Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases From a Small Bowel Adenocarcinoma: Multi-Institutional Experience. Ann Surg Oncol. 2018; 25(5): 1184–1192.
- Esquivel J, Lowy AM, Markman M, et al. The American Society of Peritoneal Surface Malignancies (ASPSM) Multiinstitution Evaluation of the Peritoneal Surface Disease Severity Score (PSDSS) in 1,013 Patients with Colorectal Cancer with Peritoneal Carcinomatosis. Ann Surg Oncol. 2014; 21(13): 4195–4201.
- Jaffré I, Bordes V, Dejode M, et al. [The role of interval surgery in the treatment's strategy of advanced ovarian cancer]. Bull Cancer. 2011; 98(1): 37–42.
- Chang SJ, Bristow RE. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining 'optimal' residual disease. Gynecol Oncol. 2012; 125(2): 483–492.
- Bois Adu, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials. Cancer. 2009; 115(6): 1234–1244.
- Eisenkop SM, Nalick RH, Teng NN. Modified posterior exenteration for ovarian cancer. Obstet Gynecol. 1991; 78(5 Pt 1): 879–885.
- Houvenaeghel G, Gutowski M, Buttarelli M, et al. Modified posterior pelvic exenteration for ovarian cancer. Int J Gynecol Cancer. 2009; 19(5): 968–973.
- Benedetti Panici P, Di Donato V, Fischetti M, et al. Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: Analysis and management of complications in upper abdominal surgery. Gynecol Oncol. 2015; 137(3): 406–411.
- Alyami M, Lundberg P, Kepenekian V, et al. BIG-RENAPE and RENAPE Working Groups. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study. Ann Surg Oncol. 2016; 23(Suppl 5): 737–745.
- Clark RM, Growdon WB, Wiechert A, et al. Patient, treatment and discharge factors associated with hospital readmission within 30 days after surgical cytoreduction for epithelial ovarian carcinoma. Gynecol Oncol. 2013; 130(3): 407–410.
- Capone A, Valle M, Proietti F, et al. Postoperative infections in cytoreductive surgery with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis. J Surg Oncol. 2007; 96(6): 507–513.
- Chi DS, Zivanovic O, Levinson KL, et al. The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas. Gynecol Oncol. 2010; 119(1): 38–42.
- Szymankiewicz M, Koper K, Dziobek K, et al. Microbiological monitoring in patients with advanced ovarian cancer before and after cytoreductive surgery – a preliminary report. Current Issues in Pharmacy and Medical Sciences. 2017; 30(4): 198–202.
- Singh S, Guetzko M, Resnick K. Preoperative predictors of delay in initiation of adjuvant chemotherapy in patients undergoing primary debulking surgery for ovarian cancer. Gynecol Oncol. 2016; 143(2): 241–245.
- Joseph N, Clark RM, Dizon DS, et al. Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer. Gynecol Oncol. 2015; 137(3): 401–405.
- Minar L, Felsinger M, Rovny I, et al. Modified posterior pelvic exenteration for advanced ovarian malignancies: a single-institution study of 35 cases. Acta Obstet Gynecol Scand. 2017; 96(9): 1136–1143.
- Sugarbaker PH. Technical handbook for the integration of cytoreductive surgery and perioperative intraperitoneal chemotherapy into the surgical management of gastrointestinal and gynecologic malignancy. 4th ed. Grand Rapids. The Ludann Company. ; 2005.
- Matsuo K, Lin YG, Roman LD, et al. Overcoming platinum resistance in ovarian carcinoma. Expert Opin Investig Drugs. 2010; 19(11): 1339–1354.
- Matsuo K, Prather CP, Ahn EH, et al. Significance of perioperative infection in survival of patients with ovarian cancer. Int J Gynecol Cancer. 2012; 22(2): 245–253.
- Tran CW, McGree ME, Weaver AL, et al. Surgical site infection after primary surgery for epithelial ovarian cancer: predictors and impact on survival. Gynecol Oncol. 2015; 136(2): 278–284.
- Nagel CI, Backes FJ, Hade EM, et al. Effect of chemotherapy delays and dose reductions on progression free and overall survival in the treatment of epithelial ovarian cancer. Gynecol Oncol. 2012; 124(2): 221–224.
- Usón PL, Bugano DD, França MS, et al. Does Time-to-Chemotherapy Impact the Outcomes of Resected Ovarian Cancer? Meta-analysis of Randomized and Observational Data. Int J Gynecol Cancer. 2017; 27(2): 274–280.
- Mahner S, Eulenburg C, Staehle A, et al. Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: analysis of prospective randomised phase III trials. Eur J Cancer. 2013; 49(1): 142–149.
- Tewari KS, Java JJ, Eskander RN, et al. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study. Ann Oncol. 2016; 27(1): 114–121.
- Feng Z, Wen H, Bi R, et al. Prognostic impact of the time interval from primary surgery to intravenous chemotherapy in high grade serous ovarian cancer. Gynecol Oncol. 2016; 141(3): 466–470.
- Aletti GD, Long HJ, Podratz KC, et al. Is time to chemotherapy a determinant of prognosis in advanced-stage ovarian cancer? Gynecol Oncol. 2007; 104(1): 212–216.
