Surgical site infection after cytoreductive surgery in patients with ovarian, fallopian tube and primary peritoneal cancer, is an independent predictor of poor overall survival via significant delays in adjuvant chemotherapy

Surgical site infection (SSI) is associated with substantial morbidity. However, the incidence and clinical significance of SSIs after cytoreductive surgery in Korean females with epithelial ovarian, fallopian tube and peritoneal cancer (EOFPC) are unknown. We aimed to assess the incidence and consequences of SSI within 30 days after cytoreductive surgery in patients with EOFPC. After estimating the effect size, SSIs were retrospectively investigated in 149 patients between 2011 and 2020. Survival and multivariate analyses were performed using Kaplan-Meier estimates and the Cox regression method that included the interaction terms, respectively. Clinical factors for patients with or without SSI were compared using the Mann-Whitney U test and Fisher’s exact test. The overall rate of SSI was 9.4% (14 of 149 patients), consisting of five superficial, three deep and six organ/space SSIs. No clinical significance of SSI was observed when analyzing the 149 cases. Among the 91 patients with FIGO stage III–IV serous type carcinomas, eight experienced SSI, and their clinical factors were compared with those of the 83 patients without SSI. A univariate analysis showed that patient age, neoadjuvant chemotherapy, suboptimal debulking status, FIGO stage, chemoresistance, a longer interval from surgery to initiation of chemotherapy (ISIC), and SSI occurrence were significantly associated with overall survival. The multivariate analysis showed that higher FIGO stage (HR 21.138; 95% CI 2.796–159.819; p = 0.003) and SSI occurrence (HR 21.999; 95% CI 2.616–184.986; p = 0.004) were independent predictors for poor overall survival. The SSI group had a significantly greater body mass index (p = 0.006) and a longer ISIC (23 ± 9.1 vs. 40.0 ± 25.7 days; p = 0.006) compared with the non-SSI group. In conclusion, SSI after cytoreductive surgery in patients with FIGO stage III–IV serous type carcinoma significantly worsened patient prognosis and delayed initiation of adjuvant chemotherapy.

Cytoreductive surgery; Ovarian cancer; Overall Survival; Surgical site infection

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