Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands.
Center of Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Department of Gynecology, Amsterdam, the Netherlands.
Gynecol Oncol. 2021 Aug;162(2):331-338. doi: 10.1016/j.ygyno.2021.05.030. Epub 2021 Jun 17.
The challenge when performing cytoreductive surgery (CRS) is to balance the benefits and risks. The aim of this study was to report short term postoperative morbidity and mortality in relation to surgical outcome in patients undergoing primary debulking surgery (PDS) or interval debulking (IDS) surgery in the Netherlands.
The Dutch Gynecological Oncology Audit (DGOA) was used for retrospective analysis. Patients undergoing PDS or IDS between January 1st, 2015 - December 31st, 2018 were included. Outcome was frequency of postoperative complications. Median time to adjuvant chemotherapy and severity of complications were related to outcome of CRS. Complications with Clavien-Dindo ≥3 were analyzed per region and case mix corrected. Statistical analysis was performed with R.Studio.
1027 patients with PDS and 1355 patients with IDS were included. Complications with re-invention were significantly higher in PDS compared to IDS (5.7% vs. 3.6%, p = 0.048). Complete cytoreduction was 69.7% in PDS and 62.1% IDS, p < 0.001. Time to adjuvant chemotherapy was 49 days in patients with complete CRS and a complication with re-intervention. Regional variation for severe complications showed one region outside confidence intervals.
Higher complete cytoreduction rate in the PDS group indicates that the correct patients have been selected, but is associated with a higher percentage of complication with re-intervention. As result, time to start adjuvant chemotherapy is longer in this group. Maintaining a balance in aggressiveness of surgery and outcome of the surgical procedure with respect to severe complications is underlined. Bench marked data should be discussed nationally to improve this balance.
实施细胞减灭术（CRS）的挑战在于平衡获益与风险。本研究旨在报告荷兰行初次肿瘤细胞减灭术（PDS）或间隔肿瘤细胞减灭术（IDS）患者的短期术后发病率和死亡率与手术结果的关系。
使用荷兰妇科肿瘤学审计（DGOA）进行回顾性分析。纳入 2015 年 1 月 1 日至 2018 年 12 月 31 日期间行 PDS 或 IDS 的患者。结局为术后并发症的发生频率。辅助化疗的中位时间和并发症的严重程度与 CRS 的结果相关。对 Clavien-Dindo ≥3 的并发症按区域和病例组合进行校正后进行分析。使用 R.Studio 进行统计分析。
纳入 1027 例行 PDS 和 1355 例行 IDS 的患者。与 IDS 相比，PDS 中再手术相关并发症的发生率明显更高（5.7% vs. 3.6%，p = 0.048）。PDS 中完全肿瘤细胞减灭率为 69.7%，IDS 为 62.1%，p < 0.001。完全肿瘤细胞减灭患者的辅助化疗中位时间为 49 天，且发生再干预相关并发症。严重并发症的区域差异显示一个区域在置信区间之外。
PDS 组中更高的完全肿瘤细胞减灭率表明已正确选择患者，但与更高比例的再干预相关并发症相关。因此，该组患者开始辅助化疗的时间更长。强调在手术的侵袭性和手术结果与严重并发症之间保持平衡。应讨论基准数据以改善这种平衡。
