Does neoadjuvant chemotherapy decrease the risk of hospital readmission following debulking surgery?

 Does neoadjuvant chemotherapy decrease the risk of hospital readmission following debulking surgery?

 Highlights

► Elderly patients undergoing either PDS or NACT-IDS have similar oncologic outcomes.
► The risk of readmission within 30 days of surgery is significantly greater among patients undergoing PDS.

Abstract

Objective

To compare primary debulking surgery (PDS) vs. neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) among elderly patients with ovarian/fallopian tube/primary peritoneal carcinoma.

Methods

Medical records of patients ≥ 70 years old with epithelial ovarian/fallopian tube/primary peritoneal carcinoma between January 2000 and December 2010 were reviewed. Patients were separated by PDS or NACT-IDS. Preoperative characteristics, surgical procedures and postoperative and oncologic outcomes were compared. Surgical procedures were given a complexity score based on a previously published method.

Results

Of 165 patients, 125 (75.8%) underwent PDS and 40 (24.2%) underwent NACT-IDS. Patients undergoing NACT-IDS were more likely to have a pleural effusion (without cytology) and stage 4 disease. Median CA-125 at diagnosis was greater for those undergoing NACT-IDS. The NACT-IDS group was associated with less intraoperative blood loss (250 vs. 400 mL, p = 0.001), a greater chance of achieving no residual disease (40% vs. 16%, p = 0.005) and a shorter hospital length of stay (LOS) (5 vs. 7 days, p < 0.001). PFS (17 vs. 15 months, p = 0.708) and OS (29 vs. 33 months, p = 0.827) were similar between the two groups. Readmission rates within 30 days of surgery were greater in those undergoing PDS (17.6% vs. 2.5%, p = 0.016). After readmission, the median hospital LOS was 6 days (range: 1–41).

Conclusions

Elderly patients undergoing PDS have similar oncologic outcomes when compared to patients undergoing NACT-IDS. The risk of readmission within 30 days of surgery is significantly greater among patients undergoing PDS.