title: Does neoadjuvant chemotherapy decrease the risk of hospital readmission following debulking surgery?
abstract: OBJECTIVE
  To compare primary debulking surgery (PDS) vs. neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) among elderly patients with ovarian/fallopian tube/primary peritoneal carcinoma.
  
  
  METHODS
  Medical records of patients ≥70 years old with epithelial ovarian/fallopian tube/primary peritoneal carcinoma between January 2000 and December 2010 were reviewed. Patients were separated by PDS or NACT-IDS. Preoperative characteristics, surgical procedures and postoperative and oncologic outcomes were compared. Surgical procedures were given a complexity score based on a previously published method.
  
  
  RESULTS
  Of 165 patients, 125 (75.8%) underwent PDS and 40 (24.2%) underwent NACT-IDS. Patients undergoing NACT-IDS were more likely to have a pleural effusion (without cytology) and stage 4 disease. Median CA-125 at diagnosis was greater for those undergoing NACT-IDS. The NACT-IDS group was associated with less intraoperative blood loss (250 vs. 400 mL, p=0.001), a greater chance of achieving no residual disease (40% vs. 16%, p=0.005) and a shorter hospital length of stay (LOS) (5 vs. 7 days, p<0.001). PFS (17 vs. 15 months, p=0.708) and OS (29 vs. 33 months, p=0.827) were similar between the two groups. Readmission rates within 30 days of surgery were greater in those undergoing PDS (17.6% vs. 2.5%, p=0.016). After readmission, the median hospital LOS was 6 days (range: 1-41).
  
  
  CONCLUSIONS
  Elderly patients undergoing PDS have similar oncologic outcomes when compared to patients undergoing NACT-IDS. The risk of readmission within 30 days of surgery is significantly greater among patients undergoing PDS.
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA.
authors: Michael J
authors: MJ
authors: Worley
authors: Stephanie H
authors: SH
authors: Guseh
authors: J Alejandro
authors: JA
authors: Rauh-Hain
authors: Kristina A
authors: KA
authors: Williams
authors: Michael G
authors: MG
authors: Muto
authors: Colleen M
authors: CM
authors: Feltmate
authors: Ross S
authors: RS
authors: Berkowitz
authors: Neil S
authors: NS
authors: Horowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen; D000077216:Carcinoma, Ovarian Epithelial; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D020360:Neoadjuvant Therapy; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D010359:Patient Readmission; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012307:Risk Factors
chemical_list: D018394:CA-125 Antigen