Sami Saarelainen

Maximal surgical effort increases the risk of postoperative complications in the treatment of advanced ovarian cancer

Surgery is the cornerstone of the treatment for advanced ovarian cancer. Reaching complete cytoreduction resulting in no gross residual disease often requires complex surgery. The aim of this study was to assess the impact of increased surgical radicality on the risk of complications in the treatment of advanced ovarian cancer. All consecutive patients with advanced ovarian cancer (FIGO Stage IIIB-IVB) who had undergone primary or interval debulking surgery during a six-year study period were identified. In the midst of the study period, a surgical practice change towards maximal surgical effort occurred. Two groups were formed for the analysis: cohort A, that consisted of patients operated before the surgical paradigm shift and cohort B, that consisted of patients operated under the period of increased surgical radicality. 252 patients were included in the analysis. Complete resection (R0) was achieved in 21.3% of surgeries in cohort A and in 51.2% in cohort B. The total postoperative complication rate was 76.2%. Most of the complications (86.5%) were minor (Clavien-Dindo I-IIIA). The patients in cohort B were at increased risk for complications, OR 2.94 (95%CI 1.58-5.47; p = 0.001). As for the approach to cytoreduction (primary vs. interval debulking), there was no statistically significant association with the occurrence of postoperative complications (p = 0.659). In the present study more extensive surgeries led to better surgical results but increased postoperative morbidity. Postoperative complication rates were similar in both primary and interval debulking surgeries.

SUROVA study: global real-world treatment strategies and mortality risk prediction in advanced ovarian cancer

This study aimed to compare 5-year overall survival between primary debulking surgery and neoadjuvant chemotherapy followed by interval surgery in patients with stage IIIB to IVB epithelial ovarian cancer, using global real-world data. Secondary objectives included evaluation of progression-free survival and the influence of race, post-operative complications, and residual disease. SUROVA is a retrospective, international cohort study involving patients treated between 2018 and 2019 across 174 centers in 55 countries. Patients underwent primary surgery or received neoadjuvant chemotherapy followed by interval surgery, per institutional protocols. Propensity score matching was based on 7 baseline variables: age, race, Eastern Cooperative Oncology Group performance status at diagnosis, CA125 level at diagnosis, FIGO (International Federation of Gynecology and Obstetrics) stage IV disease, presence of ascites, and final tumor grade. Cox regression models with time-dependent effects and interaction terms were applied. A clinical risk calculator was developed and internally validated. A total of 3286 patients had a mean age of 60.0 years (SD 12); 2978 (90.6%) had high-grade serous carcinoma, and 795 (24.7%) presented with FIGO stage IV disease. A total of 1666 patients (50.7%) underwent primary cytoreductive surgery, and 1620 (49.3%) received neoadjuvant chemotherapy. The median follow-up duration was 43.8 months (interquartile range; 22.6-59.3). After propensity score matching (n=1524), overall survival was similar between groups (67.2 vs 65.0 months; HR 1.002, 95% CI 0.85 to 1.18, p=.98). Outcomes differed by ethnicity, residual disease, and post-operative complications. Post-operative complications (28%) significantly worsened survival (66 vs 46 months; HR 1.5, 95% CI 1.2 to 1.9, p<.001), especially among patients undergoing primary surgery (73 vs 46 months; HR 1.85, 95% CI 1.43 to 2.37, p<.001). The most favorable outcomes were observed among patients with primary surgery, complete resection, and no complications, with median overall survival not reached (HR 1.25, 95% CI 1.12 to 1.40, p<.001). Although overall survival was similar between groups, treatment effects differed by ethnicity, residual disease, and complications. Post-operative complications were associated with significantly worse survival, particularly among patients undergoing primary surgery, while the best outcomes were achieved in those who had primary surgery with complete resection and no complications.

The association between low muscle mass and sarcopenic obesity, survival, and major complications in patients with advanced ovarian cancer undergoing primary cytoreductive surgery: A retrospective study

The aim of this study is to determine whether imaging-derived estimates of muscle mass or sarcopenic obesity are associated with survival and surgery-related complications in patients with advanced epithelial ovarian cancer treated with primary cytoreductive surgery (PCS). A skeletal muscle index (SMI) was determined by normalizing the muscle area at the level of third lumbar vertebra with the patient's height. Patients with SMI <38.5 cm Ninety-two patients were retrospectively included, of whom 35 (38.0 %) and 12 (13.0 %) had low muscle mass or were affected by sarcopenic obesity, respectively. Among 73 (79.3 %) patients with high-grade serous OC, the 1-year survival rates were 66.7 % and 95.3 % (hazard ratio [HR] 9.19 [95 % confidence interval (CI): 1.85-45.75]) and the 3-year survival rates were 58.3 % and 68.8 % (HR 2.95 [95 % CI: 1.10-7.92]) for patients with and without sarcopenic obesity, respectively. Neither low muscle mass nor sarcopenic obesity was associated with major complications. Sarcopenic obesity was a marker of poor 1-year and 3-year survival in patients with high-grade serous OC. Neither low muscle mass nor sarcopenic obesity was associated with major complications in PCS.