Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

Min Li; Tianjiao Zhang; Jing Zhu; Yuebo Li; Wenying Chen; Yanhu Xie; Wei Zhang; Rongzhu Chen; Wei Wei; Guihong Wang; Jiwei Qin; Weidong Zhao; Dabao Wu; Zhen Shen; Björn Nashan; Ying Zhou

doi:10.3892/ol.2022.13274

Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

Oncol Lett. 2022 May;23(5):155. doi: 10.3892/ol.2022.13274. Epub 2022 Mar 16.

Authors

Min Li¹, Tianjiao Zhang¹, Jing Zhu¹, Yuebo Li¹, Wenying Chen¹, Yanhu Xie², Wei Zhang², Rongzhu Chen³, Wei Wei⁴, Guihong Wang³, Jiwei Qin⁵, Weidong Zhao¹, Dabao Wu¹, Zhen Shen¹, Björn Nashan⁵, Ying Zhou¹

Affiliations

¹ Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.
² Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.
³ Department of Operative Nursing, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.
⁴ Department of Imaging, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.
⁵ Organ Transplantation Centre, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, P.R. China.

Abstract

The present study aimed to evaluate the postoperative complications and the impact of an enhanced recovery programme in patients who underwent primary surgery (including extensive upper abdominal surgery) for epithelial ovarian carcinoma (EOC). All patients with stage I-IV ovarian carcinoma who underwent primary surgery were identified, and postoperative complications were evaluated and graded according to the Clavien-Dindo classification. Of 161 patients, 46 (28.57%) underwent surgical staging, 27 (16.77%) standard cytoreduction, 12 (7.45%) en bloc debulking and 76 (47.20%) extraradical debulking. A total of 157 patients (97.52%) achieved optimal tumor reduction (<1 cm). The mean postoperative hospitalization time was 17.33±11.29 days after completion of the initial postoperative chemotherapy (IPC), and the IPC interval was 16.22±10.09 days. A total of 13 patients (8.07%) had grade 3 complications (9 with wound dehiscence, 3 with digestive tract leakage and 1 with a bladder fistula). A total of 2 patients (1.24%) had grade 4-5 complications [1 patient with severe pneumonia returned to the intensive care unit (ICU) for tracheotomy and respiration rehabilitation; the other patient died of septicemia on day 19]. The multivariate analysis of the preoperative factors revealed that a human epididymis protein 4 (HE4) level of ≥717 pM (P=0.015) and Federation International of Gynecology and Obstetrics (FIGO) stage IV (P=0.004; compared with stage IIIC) were associated with grade 3-5 complications. The bootstrap analysis revealed that a cancer antigen 125 (CA125) level of ≥1,012 U/ml (P=0.034), a HE4 level of ≥717 pM (P=0.007) and FIGO stage IV (P=0.002; compared with stage IIIC) were significantly associated with grade 3-5 complications. Meanwhile, the multivariate analysis of the postoperative factors did not reveal any risk factors associated with grade 3-5 complications; the bootstrap analysis revealed that only transfer to the ICU after surgery (P=0.026) was significantly associated with grade 3-5 complications. In conclusion, the study found that application of enhanced recovery after surgery protocols is feasible in patients with EOC, especially in those undergoing advanced extensive upper abdominal surgery, and CA125, HE4 and FIGO stage IV were related with the occurrence of adverse perioperative outcomes.

Keywords: complications; epithelial ovarian carcinoma; perioperative; primary surgery; recovery.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant nos. 82172773 and 81872110), the National Key Research and Development Program (grant no. 2018YFC1003900), and the 2020 USTC-Affiliated Hospital Introduction Project to Medical Leading Technology (grant no. 2020LXJS-05).