Does neoadjuvant chemotherapy decrease the risk of hospital readmission following debulking surgery? (elderly patients >70 yrs)

Abstract

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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.

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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.