Li Min, Zhang Tianjiao, Zhu Jing, Li Yuebo, Chen Wenying, Xie Yanhu, Zhang Wei, Chen Rongzhu, Wei Wei, Wang Guihong, Qin Jiwei, Zhao Weidong, Wu Dabao, Shen Zhen, Nashan Björn, Zhou Ying
Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.
Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.
Oncol Lett. 2022 May;23(5):155. doi: 10.3892/ol.2022.13274. Epub 2022 Mar 16.
The present study aimed to evaluate the postoperative complications and the impact of an enhanced recovery programme in patients who underwent primary surgery (including extensive upper abdominal surgery) for epithelial ovarian carcinoma (EOC). All patients with stage I-IV ovarian carcinoma who underwent primary surgery were identified, and postoperative complications were evaluated and graded according to the Clavien-Dindo classification. Of 161 patients, 46 (28.57%) underwent surgical staging, 27 (16.77%) standard cytoreduction, 12 (7.45%) en bloc debulking and 76 (47.20%) extraradical debulking. A total of 157 patients (97.52%) achieved optimal tumor reduction (<1 cm). The mean postoperative hospitalization time was 17.33±11.29 days after completion of the initial postoperative chemotherapy (IPC), and the IPC interval was 16.22±10.09 days. A total of 13 patients (8.07%) had grade 3 complications (9 with wound dehiscence, 3 with digestive tract leakage and 1 with a bladder fistula). A total of 2 patients (1.24%) had grade 4-5 complications [1 patient with severe pneumonia returned to the intensive care unit (ICU) for tracheotomy and respiration rehabilitation; the other patient died of septicemia on day 19]. The multivariate analysis of the preoperative factors revealed that a human epididymis protein 4 (HE4) level of ≥717 pM (P=0.015) and Federation International of Gynecology and Obstetrics (FIGO) stage IV (P=0.004; compared with stage IIIC) were associated with grade 3-5 complications. The bootstrap analysis revealed that a cancer antigen 125 (CA125) level of ≥1,012 U/ml (P=0.034), a HE4 level of ≥717 pM (P=0.007) and FIGO stage IV (P=0.002; compared with stage IIIC) were significantly associated with grade 3-5 complications. Meanwhile, the multivariate analysis of the postoperative factors did not reveal any risk factors associated with grade 3-5 complications; the bootstrap analysis revealed that only transfer to the ICU after surgery (P=0.026) was significantly associated with grade 3-5 complications. In conclusion, the study found that application of enhanced recovery after surgery protocols is feasible in patients with EOC, especially in those undergoing advanced extensive upper abdominal surgery, and CA125, HE4 and FIGO stage IV were related with the occurrence of adverse perioperative outcomes.
本研究旨在评估接受上皮性卵巢癌（EOC）初次手术（包括广泛上腹部手术）患者的术后并发症以及强化康复计划的影响。确定了所有接受初次手术的Ⅰ-Ⅳ期卵巢癌患者，并根据Clavien-Dindo分类法对术后并发症进行评估和分级。161例患者中，46例（28.57%）接受了手术分期，27例（16.77%）接受了标准细胞减灭术，12例（7.45%）接受了整块切除，76例（47.20%）接受了超根治性减瘤术。共有157例患者（97.52%）实现了最佳肿瘤缩减（<1 cm）。初次术后化疗（IPC）完成后，平均术后住院时间为17.33±11.29天，IPC间隔为16.22±10.09天。共有13例患者（8.07%）发生3级并发症（9例伤口裂开，3例消化道漏，1例膀胱瘘）。共有2例患者（1.24%）发生4-5级并发症[1例严重肺炎患者返回重症监护病房（ICU）行气管切开和呼吸康复治疗；另1例患者在第19天死于败血症]。术前因素的多变量分析显示，人附睾蛋白4（HE4）水平≥717 pM（P=0.015）和国际妇产科联合会（FIGO）Ⅳ期（P=0.004；与ⅡIC期相比）与3-5级并发症相关。自抽样分析显示，癌抗原125（CA125）水平≥1012 U/ml（P=0.034）、HE4水平≥717 pM（P=0.007）和FIGOⅣ期（P=0.002；与ⅡIC期相比）与3-5级并发症显著相关。同时，术后因素的多变量分析未发现与3-5级并发症相关的任何危险因素；自抽样分析显示，仅术后转入ICU（P=0.026）与3-5级并发症显著相关。总之，该研究发现，术后强化康复方案在EOC患者中应用是可行的，尤其是在接受晚期广泛上腹部手术的患者中，且CA125、HE4和FIGOⅣ期与围手术期不良结局的发生有关。
