title: Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: Analysis and management of complications in upper abdominal surgery.
abstract: OBJECTIVE
  To evaluate the complication rate and its impact in patients who have undergone upper abdominal surgery for treatment of advanced ovarian cancer.
  
  
  METHODS
  Patients who have undergone upper abdominal surgery including diaphragm surgery, splenectomy, distal pancreatectomy, gastric resection, liver resection and biliary surgery were considered for the study. Perioperative complications were evaluated and graded according to Clavien-Dindo.
  
  
  RESULTS
  One hundred and twenty one patients were included. Two hundred and twelve surgical procedures were performed. Thirty-six patients reported at least one complication, but 61.1% of these the complication was mild. Median hospital stay for patients with and without complication was 7 vs. 13days respectively (p<0.001). There was a significant correlation between post-operative hospital stay and the total number of surgical procedures (R=0.445, p<0.001). At multivariate analysis, diaphragmatic resection and pancreatic resection were associated with a significant increase of postoperative hospital stay, furthermore diaphragmatic resection (p=0.004), hepatic resection (p=0.004), pancreatectomy (p=0.011) and biliary surgery (p=0.049) were independent predictors of severe (G3-G4) complication.
  
  
  CONCLUSIONS
  Rate of complications of patients submitted to upper abdominal surgery for ovarian cancer is acceptable. Prediction of severe complications is the goal for its optimal management. Extensive procedures should be avoided with those patients in which optimal residual tumor could not be reached.
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy. Electronic address: violante.didonato@uniroma1.it.
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Fischetti
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Casorelli
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Perniola
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Musella
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Innocenza
authors.initials: I
authors.lastname: Palaia
authors.affiliation: Department of General Surgery and Organ Transplantation, University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Berloco
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00155 Rome, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Muzii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Advanced ovarian cancer; Complication rate; Predictors of complication rate; Predictors of postoperative morbidity; Upper abdominal surgery