Validation of a risk-based algorithm to reduce poor operative outcomes after complex surgery for ovarian cancer

Deepa Maheswari Narasimhulu, Anna Fagotti, Giovanni Scambia, Amy L. Weaver, Michaela McGree, Lorena Quagliozzi, Carrie Langstraat, Amanika Kumar, William Cliby

Research output: Contribution to journalArticlepeer-review

Abstract

Objective We developed an algorithm that identifies patients at high risk of morbidity/mortality after cytoreductive surgery for advanced ovarian cancer. We have previously shown that the Mayo triage algorithm reduces operative mortality internally, followed by validation using an external low complexity national dataset. However, validation in a higher complexity surgical setting is required before widespread acceptance of this approach, and this was the goal of our study. Methods We included patients who underwent debulking surgery (including primary or interval debulking surgery) for stage IIIC/IV ovarian cancer between October 2011 and November 2019 (SCORPION trial patients until May 2016 and non-trial patients thereafter) at Fondazione Policlinico A Gemelli, Italy. Using the algorithm, we classified patients as either high-risk or triage-appropriate and compared 30-day grade 3+ complications and 90-day mortality using a χ 2 test or Fisher's exact test. Results A total of 625 patients were included. The mean age was 58.7±11.4 years, 73.6% (n=460) were stage IIIC, and 63.0% (n=394) underwent primary debulking surgery. Surgical complexity was intermediate or high in 82.6% (n=516) of patients (95.7% (n=377) for primary surgery and 60.2% (n=139) for interval surgery), and 20.3% (n=127) were classified as high-risk. When compared with triage-appropriate patients, high-risk patients had (1) a threefold higher rate of 90-day mortality (6.3% vs 2.0%, p=0.02); (2) a higher likelihood of 90-day mortality following a grade 3+ complication (25.9% vs 10.0%, p=0.05); and (3) comparable rates of grade 3+ complications (21.3% vs 16.1%, p=0.17). Conclusion The evidence-based triage algorithm identifies patients at high risk of morbidity/mortality after cytoreductive surgery. Triage high-risk patients are poor candidates for surgery when complex surgery is required. This algorithm has been validated in heterogeneous settings (internal, national, and international) and degree of surgical complexity. Risk-based decision making should be standard of care when planning surgery for patients with advanced ovarian cancer, whether primary or interval surgery.

Original languageEnglish (US)
Pages (from-to)83-88
Number of pages6
JournalInternational Journal of Gynecological Cancer
Volume33
Issue number1
DOIs
StatePublished - Dec 14 2022

Keywords

  • cytoreduction surgical procedures
  • ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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