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Does intraoperative hypothermia contribute to postoperative morbidity in patients undergoing optimal primary surgical cytoreduction for advanced ovarian cancer?
S104
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
CA125 neg group were more likely to have evidence of extraperitoneal disease (27.6% vs 14.6%, P = 0.02). Patients with a CA125 neg recurrence more frequently underwent secondary CRS (25.9% vs. 13.4%, P = 0.03); however, there was no difference in response to second-line therapy, progression-free survival, or overall survival. Median time from recurrence to death was 29.5 months in the CA125 neg group and 26.5 months in the CA125 pos group (P = 0.06). Conclusions: The majority of CA125 neg recurrences are asymptomatic and diagnosed on surveillance CT scans. CA125 neg recurrences are associated with prior IP chemotherapy and more commonly have evidence of extraperitoneal disease at recurrence; however, their clinical outcomes are not significantly different than those of pts with CA125 pos recurrences.
CA125 at initial diagnosis (U/ml) Median (range) CA125 nadir (U/ml)Median (range) CA125 N35U/ml at initial diagnosis Carcinomatosis at initial diagnosis Ascites at initial diagnosis Residual disease after primary CRS0 mm1-10 mmN 10 mm Prior intraperitoneal chemotherapy Extraperitoneal disease at recurrence Secondary CRS
CA125 Positiven = 314
CA125 Negativen = 58
P
813 (3–38100)
333.5 (21–13150)
b 0.01
10 (2–1434)
9 (2–64)
0.28
291 (92.7%)
52 (89.7%)
0.43
230 (73.2%) 234 (74.5%) 95 (30.3%)128 (40.8)91 (29%) 59 (18.8%)
36 (62.1%) 42 (72.4%) 17 (29.3%)25 (43.1%)16 (27.6%) 20 (34.5%)
0.11 0.75 0.95
complications including but not limited to venous thromboembolism (VTE) and SSI. Logistic regression analysis was used to evaluate factors significant on univariate analysis. Results: Two hundred ninety-seven pts met the inclusion criteria. An intraoperative T b36 °C was noted in 214 pts (72.1%), and a T b36 °C at the time of abdominal closure was noted in 135 pts (45.5%). Intraoperative pressors (P= 0.02), epidural anesthesia (P = 0.01), and blood loss (P=0.01) were associated with IH. Only intraoperative pressors and epidural anesthesia were associated with IH at the time of abdominal closure (P=0.02 and b0.05, respectively). Two hundred one pts (67.7%) experienced a complication (grade 1–5); 67 pts (22.2%) experienced a grade 3 or higher complication. There was no association between IH and postoperative complications in general (P=0.48) or grade 3–5 complications (P=0.34). Univariate analysis did show an association between hematologic complications and IH; however, this did not persist on multivariate analysis (P=0.14). All other systems-based complications – including but not limited to CV, infectious, pulmonary, and wound – were not associated with IH. There was no association between IH and postoperative VTE (P=0.63), SSI (P=0.86), or abscesses (P=0.84). Conclusions: In pts who underwent optimal primary CRS for advanced ovarian cancer, IH alone was not associated with the development of postoperative complications. Postoperative morbidity in these pts is multifactorial. Further investigation into modifiable risk factors is warranted.
0.01
doi:10.1016/j.ygyno.2011.12.249
46 (14.6%)
16 (27.6%)
0.02
42 (13.4%)
15 (25.9%)
0.03
CRS = cytoreductive surgery.
doi:10.1016/j.ygyno.2011.12.247
247 Abstract Withdrawn at Author Request.
doi:10.1016/j.ygyno.2011.12.248
248 Does intraoperative hypothermia contribute to postoperative morbidity in patients undergoing optimal primary surgical cytoreduction for advanced ovarian cancer? K. Long1, E. Tanner1, M. Frey1, B. Cormier1, G. Gardner1, Y. Sonoda1, D. Levine2, C. Brown1, R. Barakat1, D. Chi1. 1Memorial Sloan-Kettering Cancer Center, New York, NY, 2Mercer University School of Medicine, Savannah, GA. Objective: Intraoperative hypothermia (IH) has been shown to be a risk factor for postoperative complications, specifically surgical site infections (SSI) and cardiovascular (CV) morbidity, in non-gynecologic surgery. The goal of this study was to evaluate the potential morbidity associated with IH during cytoreductive surgery (CRS) for advanced ovarian cancer. Methods: Patient demographics and perioperative data were collected for all patients (pts) with stage IIIC-IV ovarian, fallopian tube, and primary peritoneal carcinoma who underwent primary CRS at our institution from 2001–2010. Inclusion criteria were carcinomatosis and/or bulky upper abdominal disease and residual disease of b1 cm. Intraoperative hypothermia was defined as temperature (T) of b36.0° Celsius (C). Complications were graded using a standardized institutional grading system. Univariate analysis was performed on 21 perioperative factors, 12 systems-based complications, and specific
249 Isolated lymph node recurrence is associated with improved survival in advanced stage ovarian cancer B. Cormier, E. Tanner, J. Ducie, K. Long, S. Wethington, I. Wadhawan, M. Leitao, R. Barakat, D. Chi, G. Gardner. Memorial Sloan-Kettering Cancer Center, New York, NY. Objective: The objective of this study was to determine if the presence of isolated lymph node (LN) disease at first recurrence is associated with prognosis in advanced stage ovarian cancer. Methods: We identified all stage IIIC-IV high grade serous ovarian cancer patients (pts) with optimal (≤1 cm residual) cytoreduction performed between 2001 and 2010. Both primary debulking and neoadjuvant treatment followed by interval debulking cases were included. Based on CT scan performed at time of first recurrence, pts were identified as either isolated LN recurrence or other recurrence. LN involvement was determined based on the radiologist's interpretation and documentation of N1 cm (short axis) on CT. Patients treated solely based on an elevated CA-125 were excluded. Multivariate Cox regression and Kaplan-Meier survival analysis were utilized. Results: Of the 252 pts, 172 (72%) were stage IIIC and 70 (28%) stage IV. Neoadjuvant chemotherapy was given to 62 (25%) and complete gross resection was achieved in 101 (40%) pts. Distribution of types of recurrence was as follows: isolated LN recurrence in 40 (16%); other recurrence in 212 (84%). Pts with metastatic disease to LNs at the initial surgery (n = 80) more frequently developed isolated LN recurrence (19/80 (24%) vs 22/172 (13%), p = 0.028). Ca-125 negative recurrences were equally distributed (15% of isolated LN cases vs 16% of other recurrences, p = 0.981). Secondary cytoreduction surgery was performed in 12% of isolated LN recurrences vs 16% in other recurrences (p= 0.570). On univariate analysis age, stage, neoadjuvant treatment, intraperitoneal chemotherapy, isolated LN recurrence, and secondary cytoreductive surgery were associated with PFS and OS. On multivariate analysis, neoadjuvant chemotherapy, isolated LN recurrence and secondary cytoreduction remained independently associated with OS. In comparison to other types of recurrence, pts with isolated LN involvement had improved OS (HR 0.514 [95% CI 0.309-0.856]). Among
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
CA125 neg group were more likely to have evidence of extraperitoneal disease (27.6% vs 14.6%, P = 0.02). Patients with a CA125 neg recurrence more frequently underwent secondary CRS (25.9% vs. 13.4%, P = 0.03); however, there was no difference in response to second-line therapy, progression-free survival, or overall survival. Median time from recurrence to death was 29.5 months in the CA125 neg group and 26.5 months in the CA125 pos group (P = 0.06). Conclusions: The majority of CA125 neg recurrences are asymptomatic and diagnosed on surveillance CT scans. CA125 neg recurrences are associated with prior IP chemotherapy and more commonly have evidence of extraperitoneal disease at recurrence; however, their clinical outcomes are not significantly different than those of pts with CA125 pos recurrences.
CA125 at initial diagnosis (U/ml) Median (range) CA125 nadir (U/ml)Median (range) CA125 N35U/ml at initial diagnosis Carcinomatosis at initial diagnosis Ascites at initial diagnosis Residual disease after primary CRS0 mm1-10 mmN 10 mm Prior intraperitoneal chemotherapy Extraperitoneal disease at recurrence Secondary CRS
CA125 Positiven = 314
CA125 Negativen = 58
P
813 (3–38100)
333.5 (21–13150)
b 0.01
10 (2–1434)
9 (2–64)
0.28
291 (92.7%)
52 (89.7%)
0.43
230 (73.2%) 234 (74.5%) 95 (30.3%)128 (40.8)91 (29%) 59 (18.8%)
36 (62.1%) 42 (72.4%) 17 (29.3%)25 (43.1%)16 (27.6%) 20 (34.5%)
0.11 0.75 0.95
complications including but not limited to venous thromboembolism (VTE) and SSI. Logistic regression analysis was used to evaluate factors significant on univariate analysis. Results: Two hundred ninety-seven pts met the inclusion criteria. An intraoperative T b36 °C was noted in 214 pts (72.1%), and a T b36 °C at the time of abdominal closure was noted in 135 pts (45.5%). Intraoperative pressors (P= 0.02), epidural anesthesia (P = 0.01), and blood loss (P=0.01) were associated with IH. Only intraoperative pressors and epidural anesthesia were associated with IH at the time of abdominal closure (P=0.02 and b0.05, respectively). Two hundred one pts (67.7%) experienced a complication (grade 1–5); 67 pts (22.2%) experienced a grade 3 or higher complication. There was no association between IH and postoperative complications in general (P=0.48) or grade 3–5 complications (P=0.34). Univariate analysis did show an association between hematologic complications and IH; however, this did not persist on multivariate analysis (P=0.14). All other systems-based complications – including but not limited to CV, infectious, pulmonary, and wound – were not associated with IH. There was no association between IH and postoperative VTE (P=0.63), SSI (P=0.86), or abscesses (P=0.84). Conclusions: In pts who underwent optimal primary CRS for advanced ovarian cancer, IH alone was not associated with the development of postoperative complications. Postoperative morbidity in these pts is multifactorial. Further investigation into modifiable risk factors is warranted.
0.01
doi:10.1016/j.ygyno.2011.12.249
46 (14.6%)
16 (27.6%)
0.02
42 (13.4%)
15 (25.9%)
0.03
CRS = cytoreductive surgery.
doi:10.1016/j.ygyno.2011.12.247
247 Abstract Withdrawn at Author Request.
doi:10.1016/j.ygyno.2011.12.248
248 Does intraoperative hypothermia contribute to postoperative morbidity in patients undergoing optimal primary surgical cytoreduction for advanced ovarian cancer? K. Long1, E. Tanner1, M. Frey1, B. Cormier1, G. Gardner1, Y. Sonoda1, D. Levine2, C. Brown1, R. Barakat1, D. Chi1. 1Memorial Sloan-Kettering Cancer Center, New York, NY, 2Mercer University School of Medicine, Savannah, GA. Objective: Intraoperative hypothermia (IH) has been shown to be a risk factor for postoperative complications, specifically surgical site infections (SSI) and cardiovascular (CV) morbidity, in non-gynecologic surgery. The goal of this study was to evaluate the potential morbidity associated with IH during cytoreductive surgery (CRS) for advanced ovarian cancer. Methods: Patient demographics and perioperative data were collected for all patients (pts) with stage IIIC-IV ovarian, fallopian tube, and primary peritoneal carcinoma who underwent primary CRS at our institution from 2001–2010. Inclusion criteria were carcinomatosis and/or bulky upper abdominal disease and residual disease of b1 cm. Intraoperative hypothermia was defined as temperature (T) of b36.0° Celsius (C). Complications were graded using a standardized institutional grading system. Univariate analysis was performed on 21 perioperative factors, 12 systems-based complications, and specific
249 Isolated lymph node recurrence is associated with improved survival in advanced stage ovarian cancer B. Cormier, E. Tanner, J. Ducie, K. Long, S. Wethington, I. Wadhawan, M. Leitao, R. Barakat, D. Chi, G. Gardner. Memorial Sloan-Kettering Cancer Center, New York, NY. Objective: The objective of this study was to determine if the presence of isolated lymph node (LN) disease at first recurrence is associated with prognosis in advanced stage ovarian cancer. Methods: We identified all stage IIIC-IV high grade serous ovarian cancer patients (pts) with optimal (≤1 cm residual) cytoreduction performed between 2001 and 2010. Both primary debulking and neoadjuvant treatment followed by interval debulking cases were included. Based on CT scan performed at time of first recurrence, pts were identified as either isolated LN recurrence or other recurrence. LN involvement was determined based on the radiologist's interpretation and documentation of N1 cm (short axis) on CT. Patients treated solely based on an elevated CA-125 were excluded. Multivariate Cox regression and Kaplan-Meier survival analysis were utilized. Results: Of the 252 pts, 172 (72%) were stage IIIC and 70 (28%) stage IV. Neoadjuvant chemotherapy was given to 62 (25%) and complete gross resection was achieved in 101 (40%) pts. Distribution of types of recurrence was as follows: isolated LN recurrence in 40 (16%); other recurrence in 212 (84%). Pts with metastatic disease to LNs at the initial surgery (n = 80) more frequently developed isolated LN recurrence (19/80 (24%) vs 22/172 (13%), p = 0.028). Ca-125 negative recurrences were equally distributed (15% of isolated LN cases vs 16% of other recurrences, p = 0.981). Secondary cytoreduction surgery was performed in 12% of isolated LN recurrences vs 16% in other recurrences (p= 0.570). On univariate analysis age, stage, neoadjuvant treatment, intraperitoneal chemotherapy, isolated LN recurrence, and secondary cytoreductive surgery were associated with PFS and OS. On multivariate analysis, neoadjuvant chemotherapy, isolated LN recurrence and secondary cytoreduction remained independently associated with OS. In comparison to other types of recurrence, pts with isolated LN involvement had improved OS (HR 0.514 [95% CI 0.309-0.856]). Among