Department of Gynaecological Oncology, Royal Derby Hospital, Derby, U.K.
Anticancer Res. 2022 Apr;42(4):1979-1986. doi: 10.21873/anticanres.15676.
BACKGROUND/AIM: With a greater proportion of women with advanced ovarian cancer (AOC) successfully undergoing radical cytoreductive surgery, the demand on peri-operative resources - including intensive care (ICU) beds - is also on the rise. Extended post-operative ICU length of stay (LOS) confers increased patient morbidity and mortality. Several variables associated with prolonged ICU LOS following AOC surgery have been identified. We aimed to evaluate the predictive value of serum lactate levels.
All patients undergoing ultra-radical surgery for AOC in a large cancer centre over a 34-month period between 2018-2021 were identified via the institution tumour registry. Data were collected retrospectively via electronic care and operating records; biochemistry, radiology, and histopathology databases.
In total, 63 patients were identified. Elevated intra-operative serum lactate levels were associated with significantly longer length of ICU post-operative stay. Longer time for hyperlactaemia to normalise following surgery also conferred significantly longer ICU, high dependency and total hospital LOS. Greater blood loss, higher surgical complexity and peritoneal carcinomatosis score, and longer operating time were associated with higher - and persistently elevated - peri-operative lactate levels.
Serum lactate in the context of ultra-radical surgery for AOC represents an accessible and inexpensive marker with potential to not only reliably predict LOS, but also to serve as a dynamic prompt for early targeted intervention. Early recognition and correction of hyperlactaemia following AOC may reduce ICU LOS limiting both the resource pressure and patient morbidity/mortality sequelae.
背景/目的：随着越来越多患有晚期卵巢癌（AOC）的女性成功接受根治性细胞减灭术，对围手术期资源（包括重症监护病房（ICU）床位）的需求也在上升。延长术后 ICU 住院时间（LOS）会增加患者的发病率和死亡率。已经确定了与 AOC 手术后 ICU LOS 延长相关的几个变量。我们旨在评估血清乳酸水平的预测价值。
在 2018 年至 2021 年期间，通过机构肿瘤登记处确定了在一家大型癌症中心接受超激进手术治疗 AOC 的所有患者。通过电子护理和手术记录、生物化学、放射学和组织病理学数据库收集数据进行回顾性收集。
共确定了 63 名患者。术中血清乳酸水平升高与 ICU 术后住院时间明显延长相关。手术后高乳酸血症正常化所需的时间延长也与 ICU、高依赖和总住院 LOS 明显延长相关。更多的失血、更高的手术复杂性和腹膜癌病评分以及更长的手术时间与更高和持续升高的围手术期乳酸水平相关。
在 AOC 的超激进手术中，血清乳酸代表了一种可及且廉价的标志物，不仅具有可靠预测 LOS 的潜力，而且可以作为早期靶向干预的动态提示。AOC 后早期识别和纠正高乳酸血症可能会降低 ICU LOS，从而限制资源压力和患者发病率/死亡率的后果。
