Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4644-4653
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4644
Risk factors for postoperative delayed gastric emptying in ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Guang-Xia Cui, Zi-Jun Wang, Jin Zhao, Ping Gong, Shuai-Hong Zhao, Xiao-Xue Wang, Wen-Pei Bai, Yan Li
Guang-Xia Cui, Zi-Jun Wang, Jin Zhao, Ping Gong, Shuai-Hong Zhao, Xiao-Xue Wang, Wen-Pei Bai, Department of Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Yan Li, Department of Peritoneal Caner Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Cui GX developed the methods, performed the formal analyses and data curation, and wrote the original draft; Wang ZJ performed the data curation and the investigations; Zhao J, Gong P, and Zhao SH performed the data curation, developed the methods, and conducted the investigations; Wang XX performed the formal analyses; Bai WP and Li Y participated in the conceptualization, methodology, writing, reviewing and editing of the manuscript, and funding acquisition; All authors have read and approved the final manuscript.
Supported by Beijing Natural Science Foundation, No. 7202075 and “Beijing Hospitals Authority” Ascent Plan, No. DFL20190701.
Institutional review board statement: All the patients provided written informed consent before enrollment and the study was reviewed and approved by the ethics committee and institutional review board of Beijing Shijitan Hospital, Capital Medical University.
Informed consent statement: All the patients provided written informed consent before enrollment.
Conflict-of-interest statement: Neither the submitted paper nor any similar paper, in whole or in part, has been submitted to or published in any other scientific journal. All authors of this paper have read and approved the final submitted version and are aware that they are listed as an author on the paper. There are no financial or other interests with regard to the submitted manuscript that might be construed as a conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE Statement have been adopted in this study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Pei Bai, PhD, Chief Physician, Director, Doctor, Full Professor, Professor, Surgeon, Department of Gynaecology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian Street, Haidian District, Beijing 100038, China. baiwp@bjsjth.cn
Received: December 19, 2020
Peer-review started: December 19, 2020
First decision: January 23, 2021
Revised: January 23, 2021
Accepted: March 17, 2021
Article in press: March 17, 2021
Published online: June 26, 2021
Abstract
BACKGROUND

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has shown promising results in improving the survival of ovarian cancer patients. Although the safety profiles of CRS-HIPEC exist, more attention should be paid to gastrointestinal complications, as the procedure involves a considerable proportion of bowel resection and anastomosis.

AIM

To identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.

METHODS

A cross-sectional study was conducted. According to the inclusion and exclusion criteria, we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRS-HIPEC in Beijing Shijitan Hospital of Capital Medical University. Risk factors for delayed gastric emptying were analyzed using univariate analysis. All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.

RESULTS

Among the 77 included patients, 36.4% (28/77) had delayed gastric emptying after CRS-HIPEC. The median age and body mass index of all patients were 59 years and 22.83 kg/m2, respectively. Preoperative chemotherapy was administered in 55 patients (71%). Sixty-two patients (81%) had a history of at least one previous pelvic surgery. The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL, respectively. Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence. The median peritoneal cancer index was 16. The risk factors for delayed gastric emptying from the univariate analysis were body mass index < 23 kg/m2 (X2 = 5.059, P = 0.025), history of pelvic surgery (X2 = 4.498, P = 0.034), history of chemotherapy (X2 = 4.334, P = 0.037), operation time ≥ 7 h (X2 = 4.827, P = 0.047), and intraoperative hemorrhage ≥ 800 mL (X2 = 7.112, P = 0.008). Multivariable analysis revealed that age ≥ 70 years (HR = 7.127; 95%CI 1.122-45.264; P = 0.037) and intraoperative hemorrhage ≥ 800 mL (HR = 3.416; 95%CI 1.067-10.939; P = 0.039) were independently associated with postoperative delayed gastric emptying after CRS-HIPEC.

CONCLUSION

Postoperative gastrointestinal management, including prolonged nasogastric intubation, should be promoted for patients over 70 years or those with intraoperative bleeding exceeding 800 mL.

Keywords: Delayed gastric emptying, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Ovarian cancer, Complication, Nasogastric tube

Core Tip: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are alternatives for ovarian cancer. Delayed gastric emptying (DGE), a common complication of this procedure, can cause discomfort and decrease quality of life postoperatively. However, little attention has been paid to this complication. Identifying patients at increased risk for DGE may aid patient selection as well as postoperative gastrointestinal management. A retrospective study was conducted, and risk factors for DGE were analyzed using univariate and multivariate analyses. We found that age ≥ 70 years and intraoperative hemorrhage ≥ 800 mL were independently associated with postoperative DGE after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.