title: Analysis of postoperative complications associated with the use of anti-adhesion sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier after cytoreductive surgery for ovarian, fallopian tube and peritoneal cancers.
abstract: OBJECTIVE
  To evaluate the risk of postoperative complications related to HA-CMC use in patients undergoing optimal cytoreductive surgery for primary and recurrent ovarian, fallopian tube, and peritoneal cancers.
  
  
  METHODS
  A single institution retrospective review identified all patients undergoing optimal (≤1 cm) cytoreductive surgery for primary or recurrent ovarian, fallopian tube, and peritoneal cancers between 1/95 and 12/08. Operative details and post-operative complications (<30 days) were extracted from the medical record. Fisher's exact test, Mann-Whitney-U, and multiple regression analyses were performed to identify factors, including HA-CMC use, associated with post-operative complications.
  
  
  RESULTS
  Three hundred seventy-five cases were analyzed: HA-CMC was utilized in 168 debulking procedures. There was no difference in the incidence of overall morbidity for patients with HA-CMC compared to those without HA-CMC (OR 1.07; 95% CI: 0.68-1.67). On univariate analysis, application of HA-CMC increased the risk of pelvic abscess (OR 2.66; 95% CI: 1.21-5.86), particularly in the primary surgery setting (OR 4.65; 95% CI: 1.67-12.98) and in patients undergoing hysterectomy (OR 3.36; 95% CI: 1.18-9.53). After controlling for confounding factors using multiple linear regression, HA-CMC use approached statistical significance in predicting an increased risk of pelvic abscess but not major postoperative morbidity.
  
  
  CONCLUSIONS
  HA-CMC adhesion barrier placement at the time of optimal cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer is not associated with major postoperative complications but may be associated with increased risk of pelvic abscess.
authors.affiliation: The Kelly Gynecologic Oncology Service, Department of Gynecology & Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. lkrill1@jhmi.edu
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Krill
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Ueda
authors.forename: Melissa
authors.initials: M
authors.lastname: Gerardi
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage / Q000009:adverse effects*; D005185:Fallopian Tube Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D002266:Carboxymethylcellulose Sodium