open access

Vol 90, No 10 (2019)
Research paper
Published online: 2019-10-31
Get Citation

The parameters to estimate postoperative severe complications classified through Clavien-Dindo after upper abdominal surgery in patients with primary and recurrent ovarian cancer

Yakup Yalcin12, Burak Tatar3, Ebru Erdemoglu4, Evrim Erdemoglu5
·
Pubmed: 31686411
·
Ginekol Pol 2019;90(10):557-564.
Affiliations
  1. Department of Obstetrics and Gynecology, Istinye University School of Medicine, Istanbul, Turkey
  2. Department of Gynecologic Oncology, Medical Park Hospital, Antalya, Turkey
  3. Department of Gynecologic Oncology, Samsun Training and Research Hospital, Samsun, Turkey
  4. Department of Obstetrics and Gynecology, Isparta State Hospital, Isparta, Turkey
  5. Department of Gynecologic Oncology, Suleyman Demirel University, Isparta, Turkey

open access

Vol 90, No 10 (2019)
ORIGINAL PAPERS Gynecology
Published online: 2019-10-31

Abstract

Objectives: The more surgical effort and performing extensive upper abdominal surgery (UAS) are often required to accomplish the highest rates of optimally cytoreduction in patients with ovarian cancer. Nonetheless, the rate of complications increases with extensive surgery. We have studied the upper abdominal surgery complications by Clavien-Dindo Classification (CDC) and analyzed parameters affecting post-operative severe complications classified through Clavien-Dindo.

Material and methods: A retrospective cohort of patients diagnosed with epithelial ovarian cancer from January 1st 2009 to April 30th 2016 was evaluated. Patients who underwent at least one UAS procedure with or without optimal cytoreduction for epithelial ovarian cancer (stage IIIC–IV or recurrent) were included. Postoperative complications were recorded according to the Clavien-Dindo Classification.

Results: In total, 58 patients were included. There were 120 UAS procedures performed on the 58 patients. Diaphragm peritonectomy was the most performed surgery (50%, 29/58), and then the other UAS procedures were liver surgery (39.7%, 23/58), cholecystectomy (24.1%, 14/58), splenic surgery (24.1%, 14/58), full-thickness diaphragm resection (22.4%, 13/58), pancreatic surgery (19%, 11/58), resection of tumor from porta hepatis (17.2%, 10/58), celiac lymph node excision (8.6%, 5/58), partial gastrectomy (1.7%, 1/58), respectively. Thirteen patients (22.4%) had post-operative grade 3–5 complications according to CDC within 30 days after surgery.

Conclusions: This current study demonstrated that the addition of extensive upper abdominal surgery procedures were not associated with increased postoperative severe complications in patients with recurrent or advanced ovarian cancer. These procedures are safe and feasible for patients in need and also can be performed with acceptable mortality and morbidity.

Abstract

Objectives: The more surgical effort and performing extensive upper abdominal surgery (UAS) are often required to accomplish the highest rates of optimally cytoreduction in patients with ovarian cancer. Nonetheless, the rate of complications increases with extensive surgery. We have studied the upper abdominal surgery complications by Clavien-Dindo Classification (CDC) and analyzed parameters affecting post-operative severe complications classified through Clavien-Dindo.

Material and methods: A retrospective cohort of patients diagnosed with epithelial ovarian cancer from January 1st 2009 to April 30th 2016 was evaluated. Patients who underwent at least one UAS procedure with or without optimal cytoreduction for epithelial ovarian cancer (stage IIIC–IV or recurrent) were included. Postoperative complications were recorded according to the Clavien-Dindo Classification.

Results: In total, 58 patients were included. There were 120 UAS procedures performed on the 58 patients. Diaphragm peritonectomy was the most performed surgery (50%, 29/58), and then the other UAS procedures were liver surgery (39.7%, 23/58), cholecystectomy (24.1%, 14/58), splenic surgery (24.1%, 14/58), full-thickness diaphragm resection (22.4%, 13/58), pancreatic surgery (19%, 11/58), resection of tumor from porta hepatis (17.2%, 10/58), celiac lymph node excision (8.6%, 5/58), partial gastrectomy (1.7%, 1/58), respectively. Thirteen patients (22.4%) had post-operative grade 3–5 complications according to CDC within 30 days after surgery.

Conclusions: This current study demonstrated that the addition of extensive upper abdominal surgery procedures were not associated with increased postoperative severe complications in patients with recurrent or advanced ovarian cancer. These procedures are safe and feasible for patients in need and also can be performed with acceptable mortality and morbidity.

Get Citation

Keywords

upper abdominal surgery; Clavien-Dindo; ovarian cancer; postoperative complication

About this article
Title

The parameters to estimate postoperative severe complications classified through Clavien-Dindo after upper abdominal surgery in patients with primary and recurrent ovarian cancer

Journal

Ginekologia Polska

Issue

Vol 90, No 10 (2019)

Article type

Research paper

Pages

557-564

Published online

2019-10-31

Page views

1184

Article views/downloads

1172

DOI

10.5603/GP.2019.0097

Pubmed

31686411

Bibliographic record

Ginekol Pol 2019;90(10):557-564.

Keywords

upper abdominal surgery
Clavien-Dindo
ovarian cancer
postoperative complication

Authors

Yakup Yalcin
Burak Tatar
Ebru Erdemoglu
Evrim Erdemoglu

References (35)
  1. National Cancer Institute, Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/ovary.html (01.01.2017).
  2. Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975; 42: 101–104.
  3. Hoskins WJ. Epithelial ovarian carcinoma: principles of primary surgery. Gynecol Oncol. 1994; 55(3 Pt 2): S91–S96.
  4. McGuire WP, Hoskins WJ, Brady MF, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med. 1996; 334(1): 1–6.
  5. Armstrong DK, Bundy B, Wenzel L, et al. Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006; 354(1): 34–43.
  6. Wiggans AJ, Cass GKS, Bryant A, et al. Poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of ovarian cancer. Cochrane Database Syst Rev. 2015(5): CD007929.
  7. Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998; 69(2): 103–108.
  8. Chi DS, Eisenhauer EL, Lang J, et al. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol. 2006; 103(2): 559–564.
  9. Winter WE, Maxwell GL, Tian C, et al. Gynecologic Oncology Group Study. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007; 25(24): 3621–3627.
  10. Fanfani F, Fagotti A, Ercoli A, et al. Is There a Role for Tertiary (TCR) and Quaternary (QCR) Cytoreduction in Recurrent Ovarian Cancer? Anticancer Res. 2015; 35(12): 6951–6955.
  11. Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002; 20(5): 1248–1259.
  12. Kuhn W, Florack G, Roder J, et al. The influence of upper abdominal surgery on perioperative morbidity and mortality in patients with advanced ovarian cancer FIGO III and IV. Int J Gynecol Cancer. 1998; 8: 56–63.
  13. Eisenkop SM, Spirtos NM, Friedman RL, et al. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 2003; 90(2): 390–396.
  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205–213.
  15. Eisenhauer EL, Abu-Rustum NR, Sonoda Y, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol. 2006; 103(3): 1083–1090.
  16. 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.
  17. Gerestein CG, Damhuis RAM, Burger CW, et al. Postoperative mortality after primary cytoreductive surgery for advanced stage epithelial ovarian cancer: a systematic review. Gynecol Oncol. 2009; 114(3): 523–527.
  18. 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.
  19. Merideth MA, Cliby WA, Keeney GL, et al. Hepatic resection for metachronous metastases from ovarian carcinoma. Gynecol Oncol. 2003; 89(1): 16–21.
  20. Chen LM, Leuchter RS, Lagasse LD, et al. Splenectomy and surgical cytoreduction for ovarian cancer. Gynecol Oncol. 2000; 77(3): 362–368.
  21. Kehoe SM, Eisenhauer EL, Abu-Rustum NR, et al. Incidence and management of pancreatic leaks after splenectomy with distal pancreatectomy performed during primary cytoreductive surgery for advanced ovarian, peritoneal and fallopian tube cancer. Gynecol Oncol. 2009; 112(3): 496–500.
  22. Magtibay PM, Adams PB, Silverman MB, et al. Splenectomy as part of cytoreductive surgery in ovarian cancer. Gynecol Oncol. 2006; 102(2): 369–374.
  23. Gouy S, Chereau E, Custodio AS, et al. Surgical procedures and morbidities of diaphragmatic surgery in patients undergoing initial or interval debulking surgery for advanced-stage ovarian cancer. J Am Coll Surg. 2010; 210(4): 509–514.
  24. Eisenhauer EL, D'Angelica MI, Abu-Rustum NR, et al. Incidence and management of pleural effusions after diaphragm peritonectomy or resection for advanced mullerian cancer. Gynecol Oncol. 2006; 103(3): 871–877.
  25. Dowdy SC, Loewen RT, Aletti G, et al. Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma. Gynecol Oncol. 2008; 109(2): 303–307.
  26. Silver DF. Full-thickness diaphragmatic resection with simple and secure closure to accomplish complete cytoreductive surgery for patients with ovarian cancer. Gynecol Oncol. 2004; 95(2): 384–387.
  27. Devolder K, Amant F, Neven P, et al. Role of diaphragmatic surgery in 69 patients with ovarian carcinoma. Int J Gynecol Cancer. 2008; 18(2): 363–368.
  28. Cliby W, Dowdy S, Feitoza SS, et al. Diaphragm resection for ovarian cancer: technique and short-term complications. Gynecol Oncol. 2004; 94(3): 655–660.
  29. Montz FJ, Schlaerth JB, Berek JS. Resection of diaphragmatic peritoneum and muscle: role in cytoreductive surgery for ovarian cancer. Gynecol Oncol. 1989; 35(3): 338–340.
  30. Kapnick SJ, Griffiths CT, Finkler NJ. Occult pleural involvement in stage III ovarian carcinoma: role of diaphragm resection. Gynecol Oncol. 1990; 39(2): 135–138.
  31. Chéreau E, Ballester M, Selle F, et al. Pulmonary morbidity of diaphragmatic surgery for stage III/IV ovarian cancer. BJOG. 2009; 116(8): 1062–1068.
  32. Einenkel J, Ott R, Handzel R, et al. Characteristics and management of diaphragm involvement in patients with primary advanced-stage ovarian, fallopian tube, or peritoneal cancer. Int J Gynecol Cancer. 2009; 19(7): 1288–1297.
  33. Langstraat C, Aletti GD, Cliby WA. Morbidity, mortality and overall survival in elderly women undergoing primary surgical debulking for ovarian cancer: a delicate balance requiring individualization. Gynecol Oncol. 2011; 123(2): 187–191.
  34. Chéreau E, Ballester M, Selle F. Comparison of peritoneal carcinomatosis scoring methods in predicting resectability and prognosis in advanced ovarian cancer. Am J Obstet Gynecol. 2010; 202: 178.e1–178.e10.
  35. Ataseven B, du Bois A, Reinthaller A, et al. Pre-operative serum albumin is associated with post-operative complication rate and overall survival in patients with epithelial ovarian cancer undergoing cytoreductive surgery. Gynecol Oncol. 2015; 138(3): 560–565.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl