The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas Journal Article

  

Authors:	Chi, D. S.; Zivanovic, O.; Levinson, K. L.; Kolev, V.; Huh, J.; Dottino, J.; Gardner, G. J.; Leitao, M. M. Jr; Levine, D. A.; Sonoda, Y.; Abu-Rustum, N. R.; Brown, C. L.; Barakat, R. R.
Article Title:	The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas
Abstract:	Objective.: To assess the morbidity and mortality associated with extensive upper abdominal surgery (EUAS) performed during primary cytoreduction for advanced ovarian carcinoma. Methods.: We identified all patients who underwent EUAS during primary cytoreduction for advanced ovarian, tubal, or peritoneal cancer at our institution from 1/01 to 12/06. Major grade 3-5 complications were those that led to invasive radiologic intervention, re-operation, unplanned ICU admission, chronic disability, or death within 30 days of surgery. Results.: There were 141 eligible patients, with a median age of 60 years (range, 38-82). The majority of patients had stage IIIC disease, 103 (73%); serous histology, 131 (93%); and ascites, 118 (84%). There were 229 EUAS procedures performed-diaphragm peritonectomy, 101 (72%); splenectomy, 45 (32%); full-thickness diaphragm resection, 19 (14%); partial hepatectomy, 18 (13%); distal pancreatectomy, 17 (12%); cholecystectomy, 15 (11%); and resection of porta hepatis tumor, 14 (10%). Cytoreductive outcomes were: no gross residual, 42 (30%); residual ≤ 1 cm, 85 (60%); and residual > 1 cm, 14 (10%). Grade 3-5 complications occurred in 31 (22%) patients, including 2 mortalities (1.4%). In 21/31 (68%), the complication was successfully managed with percutaneous drainage of infected or non-infected collections. Overall median survival for all patients was 57 months. Conclusions.: Rates of major morbidity and mortality following EUAS for primary cytoreduction were 22% and 1.4%, respectively. Approximately two-thirds of complications were readily managed by percutaneous drainage of collections. With an overall median survival of 57 months in a cohort of patients with a large tumor burden, this rate of morbidity and mortality appears acceptable. © 2010 Elsevier Inc.
Keywords:	adult; aged; aged, 80 and over; middle aged; major clinical study; overall survival; histopathology; splenectomy; ascites; gastrointestinal hemorrhage; pancreas resection; cancer staging; neoplasm staging; cancer grading; ovarian cancer; cytoreductive surgery; ovarian neoplasms; peritoneum cancer; peritoneal neoplasms; abdominal abscess; incidence; morbidity; cancer mortality; postoperative complication; postoperative complications; intensive care unit; pneumothorax; operation duration; reoperation; ovary carcinoma; surgery; liver resection; complications; gynecologic surgical procedures; pleura effusion; uterine tube carcinoma; abdominal surgery; fallopian tube neoplasms; cholecystectomy; liver hilus; postoperative hemorrhage; endoscopy; operating room; partial hepatectomy; percutaneous drainage; small intestine obstruction; aspiration pneumonia; disability; duodenum ulcer; cardiopulmonary arrest; anastomosis leakage; acute respiratory failure; colon ischemia; pancreas fistula; respiratory tract intubation
Journal Title:	Gynecologic Oncology
Volume:	119
Issue:	1
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2010-10-01
Start Page:	38
End Page:	42
Language:	English
DOI:	10.1016/j.ygyno.2010.05.031
PUBMED:	20609464
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-77956651100&partnerID=40&md5=d2635520f9d5e65803225b0fa5d04a44
Notes:	--- - "Export Date: 20 April 2011" - "CODEN: GYNOA" - "Source: Scopus"

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