Ovarian cancer is the most common cause of gynecologic cancer death in the United States, with 22,280 new cases and 14,240 deaths from the disease in 2016. Despite the introduction of targeted therapies, refinements in novel chemotherapy regimens, and advances in surgical techniques, survival outcomes have remained essentially unchanged over time. Most patients with ovarian cancer are diagnosed with advanced stage disease where survival outcomes are poor.
[Photo: Dr. Bin Huang]
Ultrasound Ovarian cancer screening via ultrasound often leads to surgery when abnormalities are detected. Patients may weigh the perceived risks of surgery against the benefits of certainty. A study by Kentucky authors found that complications of such surgery, however, are infrequent. Dr. Bin Huang, associate professor of Cancer Biostatistics, University of Kentucky College of Public Health, is an author on a paper published in the special ovarian cancer screening issue of the journal Diagnostics.
The study examines complications in women undergoing surgery as a result of an abnormality detected in the Kentucky Ovarian Cancer Screening Program, an ultrasound-based program that has screened over 40,000 women from 1988 to present. The aim of the study was to evaluate complications of surgical intervention for participants in the Kentucky Ovarian Cancer Screening Program and compare results to those of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial.
A retrospective database review included 657 patients who underwent surgery for a positive screen in the Kentucky Ovarian Cancer Screening Program from 1988–2014. Data were abstracted from operative reports, discharge summaries, and office notes for 406 patients. Another 142 patients with incomplete records were interviewed by phone. Complete information was available for 548 patients. Complications were graded using the Clavien–Dindo (C–D) Classification of Surgical Complications and considered minor if assigned Grade I (any deviation from normal course, minor medications) or Grade II (other pharmacological treatment, blood transfusion). C–D Grade III complications (those requiring surgical, endoscopic, or radiologic intervention) and C–D Grade IV complications (those which are life threatening) were considered “major”. Statistical analysis was performed using SAS 9.4 software.
Complications were documented in 54/548 (10 percent) subjects. For women with malignancy, 17/90 (19 percent) had complications compared to 37/458 (8 percent) with benign pathology (p < 0.003). For non-cancer surgery, obesity was associated with increased complications (p = 0.0028). Fifty patients had minor complications classified as C–D Grade II or less. Three of four patients with Grade IV complications had malignancy (p < 0.0004). In the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, 212 women had surgery for ovarian malignancy, and 95 had at least one complication (45 percent). Of the 1080 women with non-cancer surgery, 163 had at least one complication (15 percent).
Compared to the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, the Kentucky Ovarian Cancer Screening Program had significantly fewer complications from both cancer and non-cancer surgery (p < 0.0001 and p = 0.002, respectively). Complications resulting from surgery performed as a result of the Kentucky Ovarian Cancer Screening Program were infrequent and significantly fewer than reported in the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. Complications were mostly minor (93 percent) and were more common in cancer versus non-cancer surgery.