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The aim of this study was to determine the incidence and the risk factors of venous thromboembolism (VTE) within 30 days after primary surgery for epithelial ovarian cancer (EOC).In a historical cohort study, we estimated the postoperative 30-day cumulative incidence of VTE among consecutive Mayo Clinic patients undergoing primary cytoreduction for EOC between January 2, 2003, and December 29, 2008. We tested perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program, >130 variables) as potential predictors of postoperative VTE using the Cox proportional hazards modeling.Among 569 cases of primary EOC cytoreduction and/or staging and no recent VTE, 35 developed symptomatic VTE within 30 days after surgery (cumulative incidence = 6.5%; 95% confidence interval, 4.4%-8.6%). Within the cohort, 95 (16.7%) received graduated compression stockings (GCSs), 367 (64.5%) had sequential compression devices + GCSs, and 69 (12.1%) had sequential compression devices + GCSs + postoperative heparin, with VTE rates of 1.1%, 7.4%, and 5.8%, respectively (P = 0.07, χ2 test). The remaining 38 (6.7%) received various other chemical and mechanical prophylaxis regimens. In the multivariate analysis, current or past tobacco smoking, longer hospital stay, and a remote history of VTE significantly increased the risk for postoperative VTE.Venous thromboembolism is a substantial postoperative complication among women with EOC, and the high cumulative rate of VTE within 30 days after primary surgery suggests that a more aggressive strategy is needed for VTE prevention. In addition, because longer hospital stay is independently associated with a higher risk for VTE, methods to decrease length of stay and minimize factors that contribute to prolonged hospitalization are warranted. [ABSTRACT FROM AUTHOR]

Perioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC.Perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively.The rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT.Perioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT. [ABSTRACT FROM AUTHOR]

Aberrant DNA methylation is an early event in carcinogenesis which could be leveraged to detect ovarian cancer (OC) in plasma. DNA from frozen OC tissues, benign fallopian tube epithelium (FTE), and buffy coats from cancer-free women underwent reduced representation bisulfite sequencing (RRBS) to identify OC MDMs. Candidate MDM selection was based on receiver operating characteristic (ROC) discrimination, methylation fold change, and low background methylation among controls. Blinded biological validation was performed using methylated specific PCR on DNA extracted from independent OC and FTE FFPE tissues. MDMs were tested using Target Enrichment Long-probe Quantitative Amplified Signal (TELQAS) assays in pre-treatment plasma from women newly diagnosed with OC and population-sampled healthy women. A random forest modeling analysis was performed to generate predictive probability of disease; results were 500-fold in silico cross-validated. Thirty-three MDMs showed marked methylation fold changes (10 to >1000) across all OC subtypes vs FTE. Eleven MDMs (GPRIN1, CDO1, SRC, SIM2, AGRN, FAIM2, CELF2, RIPPLY3, GYPC, CAPN2, BCAT1) were tested on plasma from 91 women with OC (73 (80%) high-grade serous (HGS)) and 91 without OC; the cross-validated 11-MDM panel highly discriminated OC from controls (96% (95% CI, 89–99%) specificity; 79% (69–87%) sensitivity, and AUC 0.91 (0.86–0.96)). Among the 5 stage I/II HGS OCs included, all were correctly identified. Whole methylome sequencing, stringent filtering criteria, and biological validation yielded candidate MDMs for OC that performed with high sensitivity and specificity in plasma. Larger plasma-based OC MDM studies, including testing of pre-diagnostic specimens, are warranted. • Whole methylome sequencing identified novel ovarian cancer methylated DNA markers. • An 11-MDM ovarian cancer panel discriminated between ovarian cancer and no cancer in plasma. • In plasma, the 11-MDM panel identified all 5 early-stage high grade serous ovarian cancers. [ABSTRACT FROM AUTHOR]

Most splenectomies performed in ovarian cancer (OC) debulking are for disease resection; the impact of splenectomy on 30-day complication and oncologic outcomes is unclear. We aimed to determine the association of splenectomy with postoperative complications, overall survival (OS), and progression-free survival (PFS) in the setting of primary debulking surgery (PDS) for OC. We retrospectively evaluated women who underwent PDS or surgical staging for OC from 1/2003-07/2016. Perioperative variables and 30-day complications defined by ACS-NSQIP were abstracted. Among those with advanced stage (IIIC/IV) disease, complications were graded using the modified Accordion grading scale; severe was defined as grade 3 or 4. A propensity score (PS) matched cohort was evaluated to limit the effect of bias due to confounding variables between patients who did and did not have a splenectomy. The severe complication rate was compared between matched pairs using McNemar's test and time-to-event outcomes were compared using stratified Cox proportional hazards models. Among 1311 patients in the cohort, 153 (11.7%) underwent splenectomy. Patients with splenectomy were more likely to have advanced stage disease (96.1 vs 60.6%), serous histology (89.5 vs 68.8%), ascites (83.0 vs 45.3%), higher median preoperative CA-125 (737 vs 388 U/mL), and residual disease (52.9 vs 31.3%), compared to patients without splenectomy (all p<0.001). In the full cohort, the risk of progression and death were significantly higher in the splenectomy group, HR 2.03 (95% CI 1.64-2.50) and HR 1.85 (95% CI 1.52-2.24), respectively (Figure A, C). In the PS-matched cohort of 151 matched pairs, this was no longer observed, HR of progression was 1.24 (95% CI 0.82-1.86) and death was 1.16 (95% CI 0.81-1.65) (Figure B, D). Among the 849 patients with stage IIIC/IV disease in the full cohort, patients with a splenectomy were more likely to have a severe 30-day complication (31.3 vs 19.1%, p=0.001); this persisted in the PS-matched cohort (31.0 vs 19.0%, p=0.02). Within 30 days, 14 (9.2%) with splenectomy had a pancreatic leak. [Display omitted] We observed that splenectomy during PDS was associated with increased risk of progression and death compared to those not undergoing splenectomy but this risk was no longer observed with a PS-matched cohort. Splenectomy appears to be a marker for disease extent but does not increase the risk of progression or decreased survival in and of itself. Splenectomy was associated with a higher risk of severe postoperative complications including a 9% risk of pancreatic leak. These findings underscore the importance of preoperative surgical risk/benefit assessment and expertise in management of complications. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC. Methods: We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon''s diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables with P ≤.20 were included in multivariate analysis. Results: Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection; P =.002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6days) and increased time to recovery of the upper (7.5 vs 4days) and lower (4 vs 3days) gastrointestinal tract (P <.001 for each). Conclusions: The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed. [Copyright &y& Elsevier]