Michael Lavie

Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study

The efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation. A retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. Among the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of P = 0.05. CT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.

Risk factors for hospital readmission following staging surgery for endometrial cancer

Endometrial cancer is the most common gynecologic malignancy, with surgical staging being the primary treatment. Despite generally favorable outcomes, postoperative complications frequently lead to unplanned hospital re-admissions, adversely affecting patient well-being and healthcare resource utilization. This study aimed to identify factors associated with hospital readmission following staging surgery for endometrial cancer. A retrospective cohort study of women undergoing staging surgery for endometrial cancer conducted between January 2016 and December 2022 at a single tertiary center. The primary outcome was hospital re-admission within 30 days of surgery. Demographics, clinical, laboratory data and pre intra and postoperative data were collected from electronic records. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of readmission. Among 470 patients, 36 (7.7 %) were readmitted within 30 days. Multivariable analysis identified four independent risk factors for readmission: Intraoperative complications (OR 15.94; 95 % CI 3.22-78.88; p < 0.001), preoperative hemoglobin < 10 g/dL (OR 5.52; 95 % CI 1.23-24.81; p = 0.026), prior abdominal surgery (OR 3.26; 95 % CI 1.29-8.74; p = 0.012) and ASA physical status classification ≥ 3 (OR 3.17; 95 % CI 1.30-7.74; p = 0.011). Most causes of readmission were fever (30.5 %), pain (22.3 %), and bleeding (16.6 %), while surgical site infections accounted for 5.6 of readmitted patients. Prolonged hospitalization was more common among readmitted patients but was not an independent predictor. Our findings confirm that previous abdominal surgery, ASA physical status classification ≥3, and preoperative anemia independently predict 30-day readmission after endometrial cancer staging surgery. These findings underscore the importance of risk stratification, optimization of preoperative status and enhanced postoperative monitoring to reduce avoidable readmissions and improve patient outcomes.

Identifying risk factors for postoperative complications following staging surgery for endometrial cancer

Endometrial cancer is the most prevalent gynecologic malignancy, with increasing incidence primarily due to aging, obesity, and diabetes. Surgical staging, a gold standard treatment involving total hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node biopsy, presents various postoperative complications influencing patient outcomes and healthcare costs. This study aims to identify risk factors associated with short term postoperative complications following staging surgery for endometrial cancer. A retrospective cohort study conducted at a single university-affiliated medical center from January 2016 to December 2022. Data were extracted from electronic medical records, including patient demographics and comorbidities, surgical data including intraoperative complications, tumor histology and surgical outcomes. A composite adverse post operative outcome was defined, including need for post-operative blood transfusion, antibiotic treatment, Intensive care unit (ICU) admission, prolonged hospitalization, and 30-day readmission rates. Among 495 patients, 34.3 % experienced at least one postoperative complication. Significant factors associated with complications included age over 65, ASA score >2, pathologic grade 3 tumours, and non-minimally invasive surgical approaches. Prolonged operative time (>75th percentile) and intraoperative complications also correlated with increased risk. Conversely, higher preoperative haemoglobin levels were protective against complications. The findings emphasize the importance of recognizing risk factors such as advanced age, elevated ASA scores, and specific tumor characteristics to enhance preoperative assessments and surgical planning. By tailoring surgical approaches and optimizing patient preparation, healthcare providers may improve postoperative outcomes and reduce complications for patients undergoing staging surgery for endometrial cancer.