Joneborg Ulrika, Palsdottir Kolbrun, Farm Erik, Johansson Hemming, Salehi Sahar
Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Eur J Surg Oncol. 2021 Feb;47(2):353-359. doi: 10.1016/j.ejso.2020.07.025. Epub 2020 Jul 31.
In advanced epithelial ovarian cancer (EOC), longer time-interval from surgery to initiation of adjuvant chemotherapy (TITC) is associated with decreased survival. Adding upper abdominal surgical procedures (UAP) increases rates of both complete gross resection and postoperative complications in EOC. Our objective was to investigate the association of UAP and TITC. Moreover, if specific postoperative monitoring after the most prevalent UAP increases early detection and management of complications.
Women diagnosed with EOC 2014-2016 in the Stockholm/Gotland Region in Sweden were identified in the Swedish Quality Registry for Gynaecologic Cancer. The association between UAP and TITC was investigated by multivariable linear regression and adjusted for predefined confounders. The follow-up and detection of postoperative complications after diaphragm resection, splenectomy and cholecystectomy was examined.
240 women were selected for analysis. The TITC in women subjected to UAP was similar with a median of 30 days (p = 0.99). Moreover, despite a higher rate of postoperative and major complications (p < 0.001) and longer hospital stay (p < 0.001), in the adjusted analysis there was no association between UAP and prolonged TITC, with a mean difference of -2.27 days (95% Confidence Interval (CI), -5.99 to -1.45, p = 0.23). After the most prevalent UAP (diaphragm resection, splenectomy and cholecystectomy), eventual postoperative interventions were based on routine clinical management rather than procedure-specific postoperative surveillance.
UAP does not prolong TITC despite an increased rate of postoperative complications and longer length of hospital stay. Clinical non-specific surveillance is sufficient to detect postoperative complications after the most prevalent UAP.
在晚期上皮性卵巢癌（EOC）中，从手术到开始辅助化疗的时间间隔（TITC）延长与生存率降低相关。增加上腹部手术操作（UAP）会提高EOC的完全大体切除率和术后并发症发生率。我们的目的是研究UAP与TITC之间的关联。此外，在最常见的UAP术后进行特定的术后监测是否能提高并发症的早期发现和处理。
在瑞典妇科癌症质量登记处中识别出2014 - 2016年在瑞典斯德哥尔摩/哥特兰地区被诊断为EOC的女性。通过多变量线性回归研究UAP与TITC之间的关联，并对预先定义的混杂因素进行调整。检查了膈切除术、脾切除术和胆囊切除术后的随访情况以及术后并发症的检测情况。
选取240名女性进行分析。接受UAP的女性的TITC相似，中位数为30天（p = 0.99）。此外，尽管术后和主要并发症发生率较高（p < 0.001）且住院时间更长（p < 0.001），但在调整分析中，UAP与TITC延长之间无关联，平均差异为 -2.27天（95%置信区间（CI），-5.99至 -1.45，p = 0.23）。在最常见的UAP（膈切除术、脾切除术和胆囊切除术）之后，最终的术后干预基于常规临床管理，而非特定手术的术后监测。
尽管术后并发症发生率增加且住院时间延长，但UAP并不会延长TITC。临床非特异性监测足以检测最常见UAP术后的并发症。
