Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: Analysis and management of complications in upper abdominal surgery

• One out of 3 patients undergoing UAS shows complications, but 60% of these are mild.
• Pleural effusion is the most common complication after UAS for ovarian debulking.
• Total number of procedures and occurrence of complications are correlated with POS.

ObjectiveTo evaluate the complication rate and its impact in patients who have undergone upper abdominal surgery for treatment of advanced ovarian cancer.MethodsPatients who have undergone upper abdominal surgery including diaphragm surgery, splenectomy, distal pancreatectomy, gastric resection, liver resection and biliary surgery were considered for the study. Perioperative complications were evaluated and graded according to Clavien–Dindo.ResultsOne hundred and twenty one patients were included. Two hundred and twelve surgical procedures were performed. Thirty-six patients reported at least one complication, but 61.1% of these the complication was mild. Median hospital stay for patients with and without complication was 7 vs. 13 days respectively (p < 0.001). There was a significant correlation between post-operative hospital stay and the total number of surgical procedures (R = 0.445, p < 0.001). At multivariate analysis, diaphragmatic resection and pancreatic resection were associated with a significant increase of postoperative hospital stay, furthermore diaphragmatic resection (p = 0.004), hepatic resection (p = 0.004), pancreatectomy (p = 0.011) and biliary surgery (p = 0.049) were independent predictors of severe (G3–G4) complication.ConclusionsRate of complications of patients submitted to upper abdominal surgery for ovarian cancer is acceptable. Prediction of severe complications is the goal for its optimal management. Extensive procedures should be avoided with those patients in which optimal residual tumor could not be reached.