title: Comparison of optimal cytoreduction rates in emergency versus non-emergency admissions for advanced ovarian cancer: a multi-institutional study.
abstract: OBJECTIVE
  to investigate whether first referral to the Emergency Department (ED) of a General Hospital is an independent risk-factor for suboptimal debulking compared to a similar population electively admitted to cytoreductive surgery, in a cohort of 307 AOC patients.
  
  
  METHODS
  this is a multicentre case-control study, analyzing a cohort of 307 AOC patients treated at San Raffaele Hospital of Milan (111 Center A) and Gemelli Hospital of Rome (196 Center B) between January 2006/2008 and December 2010. Women are classified as patients admitted to the Hospital from ED (Cases) and out-patients (Controls).
  
  
  RESULTS
  At univariate analysis, Cases significantly differ from Controls in terms of worse ECOG PS, larger ascites, pleuric effusion and peritoneal carcinomatosis. The rate of optimal cytoreduction is statistically lower in the Cases than Controls. At multivariate analysis, significant independent predictors for suboptimal residual disease resulted ED admission, peritoneal carcinosis and mesenteral involvement, supra radical surgery.
  
  
  CONCLUSIONS
  Patients admitted from Emergency Department may have a lower likelihood of optimal cytoreduction, due to their poor clinical characteristics and large diffusion of the disease.
authors.affiliation: Division of Gynecologic Oncology, San Raffaele Hospital, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mangili
authors.forename: G
authors.initials: G
authors.lastname: Scambia
authors.forename: J
authors.initials: J
authors.lastname: Ottolina
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.forename: R
authors.initials: R
authors.lastname: Viganò
authors.forename: B
authors.initials: B
authors.lastname: Costantini
authors.forename: M
authors.initials: M
authors.lastname: Candiani
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D016022:Case-Control Studies; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008643:Mesentery / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: (AOC); (ASA); (ECOG); (ED); (PS); American Society of Anesthesiologists; Cytoreduction; Eastern Cooperative Oncology Group; Emergency admission; Ovarian cancer; Performance status; Residual disease; advanced ovarian cancer; emergency admission; performance status