Bianchi Tommaso, Grassi Tommaso, De Ponti Elena, Pecis Cavagna Giorgia, Bombelli Martina, Lugotti Daniele, Testa Filippo, Totis Mauro, Trezzi Gaetano, Landoni Fabio, Fruscio Robert
Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
UO Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Ann Surg Oncol. 2025 Jun 24. doi: 10.1245/s10434-025-17619-9.
The comprehensive complication index (CCI) reflects the overall patient complication burden on a 0-100 scale. This single-institution retrospective analysis explores the accuracy of CCI in describing complications following cytoreductive surgery for advanced high-grade ovarian carcinoma (HGOC) and aims to identify predictive factors of high complication burden.
In total, 304 patients who underwent cytoreductive surgery for FIGO stage IIIA-IVB HGOC at our institution from 2015 to 2023 were analyzed. Each complication's severity was graded using the Clavien-Dindo classification. The CCI was used to quantify the global complications burden, and patients were stratified into three groups: CCI-low (< 26.2), CCI-intermediate (26 ≤ CCI < 33.7), and CCI-high (≥ 33.7).
Of the 200 patients (65.8%) with at least one complication, 127 (41.8%) were CCI-low, 32 (10.5%) CCI-intermediate, and 41 (13.5%) CCI-high. Median hospitalization duration (p < 0.0001) and readmission rates (p < 0.0001) correlated with CCI categories, reflecting increased CCI scores with greater surgical complexity, as assessed by the Aletti surgical complexity score (SCS). Univariate analysis showed a significant association between CCI-high and FIGO stage, surgical complexity, diaphragmatic procedures, multiple bowel resections, length of surgery and intraoperative blood loss. Multivariate analysis confirmed FIGO stage (odds ratio [OR] 2.57), multiple bowel resections (OR 5.61), and blood loss (OR 1.93) as independent risk factors for high complication burden.
The CCI is a good descriptor of postoperative complications in patients undergoing cytoreductive surgery for advanced HGOC by integrating both the severity and number of complications into a single, easily usable, and intuitive quantitative score. FIGO stage, multiple bowel resections, and blood loss-but not surgical timing-are independent predictors of a high complication burden.
综合并发症指数（CCI）在0至100的范围内反映患者总体并发症负担。这项单机构回顾性分析探讨了CCI在描述晚期高级别卵巢癌（HGOC）减瘤手术后并发症方面的准确性，并旨在确定高并发症负担的预测因素。
对2015年至2023年在本机构接受FIGO IIIA-IVB期HGOC减瘤手术的304例患者进行分析。使用Clavien-Dindo分类法对每种并发症的严重程度进行分级。CCI用于量化总体并发症负担，患者被分为三组：低CCI组（<26.2）、中CCI组（26≤CCI<33.7）和高CCI组（≥33.7）。
在200例（65.8%）至少有1种并发症的患者中，127例（41.8%）为低CCI组，32例（10.5%）为中CCI组，41例（13.5%）为高CCI组。中位住院时间（p<0.0001）和再入院率（p<0.0001）与CCI类别相关，反映出随着Aletti手术复杂性评分（SCS）评估的手术复杂性增加，CCI评分升高。单因素分析显示，高CCI组与FIGO分期、手术复杂性、膈肌手术、多次肠切除术、手术时长和术中失血之间存在显著关联。多因素分析证实FIGO分期（比值比[OR]2.57）、多次肠切除术（OR 5.61）和失血（OR 1.93）是高并发症负担的独立危险因素。
CCI通过将并发症的严重程度和数量整合为一个单一、易于使用且直观的定量评分，是晚期HGOC减瘤手术患者术后并发症的良好描述指标。FIGO分期、多次肠切除术和失血——而非手术时机——是高并发症负担的独立预测因素。
