The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .
Thirty-Day Mortality After Primary Cytoreductive Surgery for Advanced Ovarian Cancer in the Elderly
OBJECTIVE : To identify factors associated with increased 30-day mortality after advanced ovarian cancer debulking among elderly women . METHODS : A data base linking Medicare records with the Surveillance , Epidemiology , and End Results ( SEER ) data was used to identify a cohort of 5,475 women aged 65 and older who had primary debulking surgery for stage III or IV epithelial ovarian cancer ( diagnosed 1995–2005 ) . Women were stratified by acuity of hospital admission . Multivariable analysis was performed to identify patient-related and treatment-related variables associated with 30-day mortality . RESULTS : Five thous and four hundred seventy-five women had surgery for advanced ovarian cancer , and the overall 30-day mortality was 8.2 % . Women admitted electively had a 30-day mortality of 5.6 % ( 251 of 4,517 ) , and those admitted emergently had a 30-day mortality of 20.1 % ( 168 of 835 ) . Advancing age , increasing stage , and increasing comorbidity score were all associated with an increase in 30-day mortality ( all P<.05 ) among elective admissions . A group of women at high risk admitted electively included those aged 75 or older with stage IV disease and women aged 75 or older with stage III disease and a comorbidity score of 1 or more . This group had an observed 30-day mortality of 12.7 % ( 95 % confidence interval 10.7%–14.9 % ) . CONCLUSION : Age , cancer stage , and comorbidity scores may be helpful to stratify electively admitted patients based on predicted postoperative mortality . If vali date d in a prospect i ve cohort , then these factors may help identify women who may benefit from alternative treatment strategies . LEVEL OF EVIDENCE :
The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .