The influence of upper abdominal surgery on perioperative morbidity and mortality in patients with advanced ovarian cancer FIGO III and FIGO IV

Tumor debulking procedures are routinely performed in advanced ovarian cancer patients, however, data on perioperative morbidity and mortality due to specific organ-oriented procedures are few. In a retrospective analysis, peri-operative morbidity and mortality as well as overall survival were analyzed in patients with advanced ovarian cancer. 41 patients (group A) underwent upper abdominal surgery. In 66 patients (group B), standard debulking procedure without upper abdominal surgery was performed. All data of surgical and peri-operative intensive care therapy differed significantly in both groups (P < 0.01). The morbidity was also significantly different. In group A, serious complications (including mortality) were significantly more often seen in patients undergoing splenectomy, cholecystectomy and partial pancreatic resection (n = 23) than in patients requiring only resection of the diaphragmatic peritoneum (n = 18) (P = 0.045). Tumor-free patients in both groups had a longer median survival time than patients with residual tumor (group A: 71 vs. 15 months; group B: > 60 vs. 17 months, P < 0.01). Resection of tumorous diaphragmatic peritoneum suggests that survival improves if complete tumor removal is feasible. Other forms of upper abdominal surgery, including splenectomy and partial pancreatic resection, have a high rate of morbidity and mortality and probably no benefit in terms of survival. Therefore the risk-benefit ratio of these latter procedures has to be evaluated separately in each case.