Despite complications, more complex surgery improves ovarian cancer

In patients with advanced ovarian cancer who undergo primary surgery, factors such as surgical complexity have a significant effect on short-term morbidity and overall survival, according to a report published in the December issue of the American Journal of Obstetrics and Gynecology.

Giovanni D. Aletti, MD, of the Mayo Clinic in Rochester, MN., and colleagues studied 219 patients with stage IIIC-IV ovarian cancer.

The researchers found that poor performance status, age, and extent or complexity of surgery were all independently associated with major morbidity. They found that age and performance status-but not surgical complexity-predicted 3-month mortality. They also observed that surgical complexity independently predicted overall survival. Among the risk prediction categories developed by the researchers, the risk of expected complications ranged from 2.5% to 67.6%. In all risk groups, however, more complex surgery carried a survival benefit.

"Because of the survival benefit from lower residual disease, a less aggressive surgical effort results in poorer overall survival," the authors conclude. "However, the risk of complications are substantial for complex surgeries in the highest-risk patients: risk stratification should be used to help plan perioperative care and consider optimal treatment planning."

Aletti GD, Dowdy SC, Podratz KC, et al. Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obstet Gynecol. 2007;197:676.e1-676.e7.