Lina Salman

Postoperative Complications in Elderly Patients Undergoing Surgery for Ovarian Cancer: A NSQIP Analysis

ABSTRACTBackground and ObjectivesElderly patients with ovarian cancer (OC) commonly receive modified treatment due to the assumption of higher risk. The aim of this study is to evaluate postoperative complications in elderly patients undergoing surgery for OC.MethodsRetrospective cohort study of patients with OC identified in the NSQIP database, (2013–2021). Younger patients included 40–69 years old, and elderly patients were ≥ 70 years old. Major complications included: pulmonary embolism, deep vein thrombosis, acute kidney injury, stroke, cardiac arrest, space surgical site infection, myocardial infarction, sepsis, septic shock, and return to the operating room.ResultsOf the 11,108 patients, 8214 (74%) were in the younger patient and 2894 (26%) in the elderly patient group. Elderly patients had higher rates of postoperative pneumonia (2.6% vs. 1.2%), myocardial infarction (1.4% vs. 0.3%), and major complications (3.5% vs. 2.0%), p < 0.0001 for all. Discharge to rehab was higher in elderly patients (3.1% vs. 0.5%, p < 0.001). On multivariate logistic regression, older age was associated with “major complications” (aOR 1.79, 95% CI 1.38–2.31, p < 0.0001).ConclusionsIn OC patients selected for surgery, elderly patients are at higher risk of Postoperative complications and are less likely to be discharged home. This should be considered when counseling patients pre‐operatively and planning for peri‐operative care and disposition.

Anastomotic diversion rates following integration of indocyanine green fluorescence angiography in cytoreductive surgery for ovarian cancer

To compare rates of diverting ileostomy in patients with ovarian cancer, undergoing cytoreduction with bowel resection before and after the acquisition of indocyanine green fluorescence angiographic scans for anastomotic perfusion assessment. A retrospective cohort study of patients with ovarian cancer undergoing bowel resection during cytoreductive surgery between 2010 and 2021. We evaluated whether using indocyanine green fluorescence angiography impacted rates of diverting ileostomy. Baseline characteristics and rates of diversion were compared between those who had indocyanine green fluorescence assessment and those with bowel resection without anastomotic fluorescence assessment. Overall, 181 patients were included. Of whom, 84 (46%) underwent anastomotic fluorescence assessment following bowel resection, and 97 (54%) had bowel resection without assessment. Mean age of the cohort was 58.2 years and 132 (73%) had stage III disease. There was no difference between groups in rates of diverting ileostomy (41% vs 41%, p=1.0). In a univariable logistic regression, the odds of having an ileostomy were 2.92 times higher in patients undergoing primary surgery than in patients undergoing interval cytoreductive surgery (95% CI 1.25 to 6.85, p=0.013). The use of fluorescence angiography did not predict performing diverting ileostomy (OR=0.97, 95% CI (0.53 to 1.76), p=0.92). In this cohort, the simple introduction of indocyanine green fluorescence angiography had no impact on the rates of anastomotic diversion. Developing a systematic, reproducible diversion protocol with selection criteria that include fluorescence angiography is needed to assess the impact of this surgically innovative tool on the rates of anastomotic diversion in patients with advanced ovarian cancer.

Simple perinephric adipose tissue measurement for prediction of failed sentinel lymph node mapping in endometrial cancer

We aimed to evaluate whether pre-operative average perinephric fat is associated with sentinel lymph node (SLN) mapping, peri-operative complications, and survival in endometrial cancer. This was a retrospective cohort study of endometrial cancer patients who underwent surgical staging with SLN mapping between 2015 and 2021. Average perinephric fat was measured on axial sections of pre-operative computed tomography scans. Baseline characteristics and average perinephric fat measurements were compared between patients with successful mapping and those with bilateral failed mapping. We also compared peri-operative complications between patients with high and low average perinephric fat. Of the 297 participants included, 274 (92%) had at least unilateral successful SLN mapping, while 23 (8%) had bilateral failed SLN mapping. Median body mass index (34.7 vs 29.8 kg/m Increased average perinephric fat is associated with a higher risk of failed SLN mapping in endometrial cancer, without an associated increase in peri-operative complications. Incorporating this simple measurement into clinical practice may add value in identifying and counseling individuals at higher risk for failed mapping.

Factors influencing surgeons' decision for diverting ileostomy and associated complications in ovarian cancer cytoreductive surgery.

This study aimed to identify factors influencing the decision to perform diverting ileostomy during cytoreductive surgery with colon resection for advanced ovarian cancer and investigate the associated complications and survival outcomes. This was a retrospective cohort study of patients with advanced ovarian cancer who underwent cytoreductive surgery with colon resection and re-anastomosis between January 2010 and July 2020. Multivariate analysis was performed on the factors contributing to diverting ileostomy identified in the univariate analysis. Of the 134 patients, 60 (44.8%) underwent diverting ileostomies. The median follow-up was 35.75 months (range; 0.03-145.05) and the median age was 57 (range; 26-86). The anastomotic leakage rate was 3.7% (n = 5). On the univariate analysis, longer operative time (10 vs 6.4 hours), multiple bowel resections (>1 vs 1 hour), total colon resection length, pre-operative paracentesis, intraoperative ascites, and transfusion were associated with diverting ileostomy. In the multivariate analysis, longer operative time (OR 1.61, p < .0001) and total colon resection length (OR 1.06, p = .027) remained significant. Diverting ileostomy was associated with higher rates of intensive care unit admission (14.3% vs 2.8%, p = .001), dehydration (40% vs 9.5%, p < .0001), and acute kidney injury (16.4% vs 1.4%, p = .002). The median progression-free survival was similar (23.87 vs 21.24 months in non-diverted vs diverted ileostomy, p = .82). Longer operative time and total length of colon resection influenced the selection of diverting ileostomy. The patients selected for diversion underwent multiple bowel resections more frequently, received more transfusions, and developed intraoperative ascites. These findings suggest that surgeons favor diversion for more extensive procedures. Patients who underwent diverted ileostomy experienced more short-term complications, likely reflecting the surgical complexity. Progression-free survival remained similar between the 2 groups, with diverse patients experiencing stoma-related morbidity over time, mainly dehydration and acute kidney injury. A prospective model to predict anastomotic leak risk may reduce diverting ileostomy rates.