title: Nomogram for 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.
abstract: OBJECTIVE
  Extensive surgical procedures to achieve maximal cytoreduction in patients with advanced stage epithelial ovarian cancer (EOC) are inevitably associated with postoperative morbidity and mortality. This study aimed to identify preoperative predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC and to develop a nomogram for individual risk assessment.
  
  
  METHODS
  Patients in The Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007. All peri- and postoperative complications within 30 days after surgery were registered and classified. To investigate predictors of 30-day morbidity, a Cox proportional hazard model with backward stepwise elimination was utilized. The identified predictors were entered into a nomogram. The main outcome was to identify parameters that predict operative risk.
  
  
  RESULTS
  293 patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. Thirty-day morbidity was seen in 99 (34%) patients. Morbidity could be predicted by age (p = 0.033; OR 1.024), preoperative hemoglobin (p = 0.194; OR 0.843), and WHO performance status (p = 0.015; OR 1.821) with a optimism-corrected c-statistic of 0.62. Determinants co-morbidity status, serum CA125 level, platelet count, and presence of ascites were comparable in both groups.
  
  
  CONCLUSIONS
  Thirty-day morbidity after primary cytoreductive surgery for advanced stage EOC could be predicted by age, hemoglobin, and WHO performance status. The generated nomogram could be valuable for predicting operative risk in the individual patient.
authors.forename: G M
authors.initials: GM
authors.lastname: Nieuwenhuyzen-de Boer
authors.forename: C G
authors.initials: CG
authors.lastname: Gerestein
authors.forename: M J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: C W
authors.initials: CW
authors.lastname: Burger
authors.forename: G S
authors.initials: GS
authors.lastname: Kooi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D049451:Nomograms; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D055815:Young Adult