Impact of Ascites on the Perioperative Course of Patients With Advanced Ovarian Cancer Undergoing Extensive Cytoreduction: Results of a Study on 119 Patients

Feldheiser, Aarne MD*; Braicu, Elena-Ioana MD; Bonomo, Tommaso MD; Walther, Anne MD*; Kaufner, Lutz MD*; Pietzner, Klaus MD; Spies, Claudia MD, PhD*; Sehouli, Jalid MD, PhD; Fotopoulou, Christina MD, PhD

International Journal of Gynecological Cancer: March 2014 - Volume 24 - Issue 3 - p 478–487
doi: 10.1097/IGC.0000000000000069
Ovarian Cancer

Objective: Cytoreductive surgery for epithelial ovarian cancer (EOC) is the cornerstone of multimodal therapy and considered as a high-risk surgery because of extensive multivisceral procedures. In most patients, ascites is present, but its impact on the surgical and clinical outcomes is unclear.

Methods: One hundred nineteen patients undergoing surgical cytoreduction because of EOC between 2005 and 2008 were included. All surgical data and the individual tumor pattern were collected systematically based on a validated documentation tool (intraoperative mapping of ovarian cancer) during primary surgery. The amount of ascites was determined at the time of surgery, and 3 groups were classified (no ascites [NOA, n = 56], low amount of ascites [< 500 mL, n = 42], and high amount of ascites [HAS > 500 mL, n = 21]).

Results: Group NOA compared with HAS showed less transfusions of packed red blood cells (median [quartiles], 0 [0–2] vs 0 [0–2] vs 3 [1–4] U; P < 0.001) and fresh frozen plasma (median [quartiles], 0 [0–2] vs 0 [0–4] vs 2 [2–6] U; P < 0.001). In addition, in patients with ascites, noradrenaline was administered more frequently and in higher doses. The postoperative length of stay in the intensive care unit was significantly shorter in the NOA versus the group with low amount of ascites and HAS (median [quartiles], 1 [0–1] vs 1 [0–2] vs 2 [1–5] days; P < 0.001). The hospital length of stay is extended in HAS compared with that in NOA (median [quartiles], 16 [13–20] vs 17 [14–22] vs 21 [17–41] days; P = 0.004). Postoperative complications were increased in patients with ascites at the time of surgery (P = 0.007).

Conclusions: The presence of a high amount of ascites at cytoreductive surgery because of EOC is associated with higher amounts of blood transfusions, whereas the length of hospital stay and the postoperative intensive care unit treatment are significantly prolonged compared with those of patients without ascites.

*Department of Anesthesiology and Intensive Care Medicine, CampusVirchow-Klinikum and Campus Charité Mitte, and †Department ofGynecology, European Competence Center for Ovarian Cancer, Campus Virchow-Klinikum, Charité–Universitaetsmedizin Berlin, Berlin, Germany; and ‡UO di Anestesia e Rianimazione 1, Ospedale Luigi Sacco, Milan, Italy.

Address correspondence and reprint requests to Aarne Feldheiser, MD, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité–Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail: aarne.feldheiser@charite.de.

The authors declare no conflicts of interest.

Received August 17, 2013

Accepted November 19, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.