Impact of ascites on the perioperative course of patients with advanced ovarian cancer undergoing extensive cytoreduction: results of a study on 119 patients.
OBJECTIVE
Cytoreductive surgery for epithelial ovarian cancer (EOC) is the cornerstone of multimodal therapy and considered as a high-risk surgery because of extensive multivisceral procedures. In most patients, ascites is present, but its impact on the surgical and clinical outcomes is unclear.


METHODS
One hundred nineteen patients undergoing surgical cytoreduction because of EOC between 2005 and 2008 were included. All surgical data and the individual tumor pattern were collected systematically based on a validated documentation tool (intraoperative mapping of ovarian cancer) during primary surgery. The amount of ascites was determined at the time of surgery, and 3 groups were classified (no ascites [NOA, n = 56], low amount of ascites [< 500 mL, n = 42], and high amount of ascites [HAS > 500 mL, n = 21]).


RESULTS
Group NOA compared with HAS showed less transfusions of packed red blood cells (median [quartiles], 0 [0-2] vs 0 [0-2] vs 3 [1-4] U; P < 0.001) and fresh frozen plasma (median [quartiles], 0 [0-2] vs 0 [0-4] vs 2 [2-6] U; P < 0.001). In addition, in patients with ascites, noradrenaline was administered more frequently and in higher doses. The postoperative length of stay in the intensive care unit was significantly shorter in the NOA versus the group with low amount of ascites and HAS (median [quartiles], 1 [0-1] vs 1 [0-2] vs 2 [1-5] days; P < 0.001). The hospital length of stay is extended in HAS compared with that in NOA (median [quartiles], 16 [13-20] vs 17 [14-22] vs 21 [17-41] days; P = 0.004). Postoperative complications were increased in patients with ascites at the time of surgery (P = 0.007).


CONCLUSIONS
The presence of a high amount of ascites at cytoreductive surgery because of EOC is associated with higher amounts of blood transfusions, whereas the length of hospital stay and the postoperative intensive care unit treatment are significantly prolonged compared with those of patients without ascites.
*Department of Anesthesiology and Intensive Care Medicine, CampusVirchow-Klinikum and Campus Charité Mitte, and †Department ofGynecology, European Competence Center for Ovarian Cancer, Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany; and ‡UO di Anestesia e Rianimazione 1, Ospedale Luigi Sacco, Milan, Italy.
Aarne
A
Feldheiser
Elena-Ioana
EI
Braicu
Tommaso
T
Bonomo
Anne
A
Walther
Lutz
L
Kaufner
Klaus
K
Pietzner
Claudia
C
Spies
Jalid
J
Sehouli
Christina
C
Fotopoulou
D000368:Aged; D001201:Ascites / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000150:complications* / Q000601:surgery*; D059035:Perioperative Period / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome