A laparoscopic risk-adjusted model to predict major complications after primary debulking surgery in ovarian cancer: A single-institution assessment.
To develop and validate a simple adjusted laparoscopic score to predict major postoperative complications after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (AEOC).



From January 2006 to June 2015, preoperative, intraoperative, and post-operative outcome data from patients undergoing staging laparoscopy (S-LPS) before receiving PDS (n=555) were prospectively collected in an electronic database and retrospectively analyzed. Major complications were defined as levels 3 to 5 of MSKCC classification. On the basis of a multivariate regression model, the score was developed using a random two-thirds of the population (n=370) and was validated on the remaining one-third patients (n=185).



Major complication rate was 18.3% (102/555). Significant predictors included in the scoring system were: poor performance status, presence of ascites (>500cm(3)), CA125 serum level (>1000U/ml), and high laparoscopic tumor load (predictive index value, PIV ≥8). The mean risk of developing major postoperative complications was 3.7% in patients with score 0 to 2, 13.2% in patients with score 3 to 5, 37.1% in patients with score 6 to 8. In the validation population, the predicted risk of major complications was 17.8% (33/185) versus a 16.7% (31/185) observed risk (C-statistic index=0.790).



This new score may accurately predict a patient's postoperative outcome. Early identification of high-risk patients could help the surgeon to adopt tailored strategies on individual basis.
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: giuseppevizzielli@yahoo.it.
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Vizzielli
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Costantini
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Tortorella
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy; Division of Gynecologic Oncology, University of Palermo, Palermo, Italy.
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Pitruzzella
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Gallotta
Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Italy.
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Fanfani
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Gueli Alletti
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Cosentino
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Nero
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Scambia
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy; University of Perugia, Perugia, Italy.
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Fagotti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D055815:Young Adult
Laparoscopy; Ovarian cancer; Post-operative complications; Predictive model