title: Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer.
abstract: OBJECTIVE
  Cytoreductive surgery is associated with extensive morbidity and may delay chemotherapy. We examined the associations among cytoreduction, perioperative complications, and delay or omission of chemotherapy.
  
  
  METHODS
  Women aged 65 years or older with stage III-IV ovarian cancer who were treated with surgery from 1991-2005 and recorded in the Surveillance, Epidemiology, and End Results-Medicare database were examined. We estimated the influence of extended cytoreduction as well as the occurrence of major perioperative complications on receipt and timing of chemotherapy and survival.
  
  
  RESULTS
  Among 3,991 patients, 479 (12%) failed to receive chemotherapy. Of those treated with chemotherapy, 2,527 (72%) initiated treatment within 6 weeks of surgery, 838 (24%) within 6-12 weeks, and 147 (4%) more than 12 weeks after surgery. In a multivariable model, older patients, those with comorbidities, mucinous tumors, and stage IV neoplasms were more likely not to receive chemotherapy (P<.05). Extended cytoreduction and the occurrence of postoperative complications were not associated with omission of chemotherapy but were associated with chemotherapy delay. For every 14 patients who underwent one extended procedure and for every 13 who had two extended procedures, one patient had a delay in receipt of chemotherapy. For every 14 patients who had one complication and for every four who had two complications, one patient had a delay in receipt of chemotherapy. The occurrence of more than two perioperative complications (hazard ratio 1.31, 95% confidence interval [CI] 1.15-1.49) and initiation of chemotherapy more than 12 weeks after surgery (hazard ratio 1.32, 95% CI 1.07-1.64) were associated with decreased survival.
  
  
  CONCLUSIONS
  Extended cytoreductive surgery and perioperative complications significantly delay initiation but do not increase the chance of omission of chemotherapy for women with ovarian cancer.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, Mailman School of Public Health, and the Herbert Irving Comprehensive Cancer Center, New York, New York 10032, USA. jw2459@columbia.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000005:Abdomen; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D016015:Logistic Models; D008197:Lymph Node Excision; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D011183:Postoperative Complications; D018426:SEER Program; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents