Predictors of postoperative morbidity and delayed initiation of adjuvant chemotherapy after cytoreductive surgery in advanced-stage epithelial ovarian cancer

This study aimed to identify the factors predicting postoperative morbidity after cytoreductive surgery in patients with advanced-stage epithelial ovarian cancer, to evaluate the effect of this morbidity on the time to initiation of adjuvant chemotherapy, and to examine the association between delayed chemotherapy and survival outcomes.

Patients with FIGO stage III–IV epithelial ovarian cancer who underwent surgery at a tertiary university hospital between May 2020 and December 2024 were retrospectively evaluated. Severe postoperative complications were defined as Clavien–Dindo grade IIIa or higher. Initiation of adjuvant chemotherapy later than 42 days after surgery was considered delayed. Clinical, laboratory, and perioperative variables associated with postoperative complications were analyzed using univariable and multivariable logistic regression analyses. Survival analyses were performed separately in the primary debulking surgery (PDS) and interval debulking surgery (IDS) groups.

A total of 180 patients were included in the study, and 20 (11.1%) developed postoperative complications. In comparative analyses, bowel surgery (OR 3.55, 95% CI 1.32–9.34, p = .010), perioperative transfusion (OR 5.28, 95% CI 1.84–19.05, p = .004), and postoperative transfusion (OR 3.17, 95% CI 1.20–9.34, p = .025), were found to be significantly more frequent in the group that developed complications. In multivariable analysis, only perioperative transfusion was identified as an independent risk factor for postoperative complications (OR: 3.72; 95% CI: 1.17–14.25; p = .035). No significant association was found between the time to initiation of adjuvant chemotherapy and most patient- and surgery-related variables; however, chemotherapy was initiated earlier in patients who underwent IDS. In survival analyses, no significant association was observed between the timing of chemotherapy initiation and progression-free survival or overall survival in the PDS group, whereas in patients undergoing IDS, early initiation of chemotherapy was associated with significantly improved overall survival (p = .0013).

In advanced-stage epithelial ovarian cancer, morbidity after cytoreductive surgery appears to be more closely related to surgery-related factors. Timely initiation of adjuvant chemotherapy may be particularly important for overall survival, especially in patients undergoing IDS.