Postoperative Intestinal Fistula in Primary Advanced Ovarian Cancer Surgery

Figures & data

Table 1 Clinicopathological Characteristics of All Patients

	Total	No	Yes	P value
	n=107	n=95 (89%)	n=12 (11%)
Age	60±10.5	60±10.6	62±10.6	0.52
FIGO stage				0.49
III	80 (74.8%)	72 (75.8%)	8 (66.7%)
IV	27 (25.2%)	23 (24.2%)	4 (33.3%)
Charlson	2±2.2	2±2.1	3±2.4	0.36
Charlson category				0.31
CHR0	40 (37.4%)	36 (37.9%)	4 (33.3%)
CHR1–3	33 (30.8%)	31 (32.6%)	2 (16.7%)
CHR4–8	34 (31.8%)	28 (29.5%)	6 (50%)
Preoperative malnutrition				0.090
No	83 (77.6%)	76 (80%)	7 (58.3%)
Yes	24 (22.4%)	19 (20%)	5 (41.7%)
Duration (min) of surgery	440±163	434±162.8	490±162.2	0.26
Operative PCI	14±9.4	13±9.1	20±9.9	0.027
Operative PCI category				0.14
1–10	43 (41.7%)	41 (45%)	2 (16.7%)
11–20	35 (34.0%)	30 (33%)	5 (41.7%)
+20	25 (24.3%)	20 (22%)	5 (41.7%)
Ascitis				0.98
NO	80 (74.8%)	71 (74.7%)	9 (75%)
SI	27 (25.2%)	24 (25.3%)	3 (25%)
Partial bowel obstruction				0.017
No	94 (87.9%)	86 (90.5%)	8 (66.7%)
Yes	13 (12.1%)	9 (9.5%)	4 (33.3%)
Diffuse intestinal or mesos infiltration				0.25
No	85 (79.4%)	77 (81.1%)	8 (66.7%)
Yes	22 (20.6%)	18 (18.9%)	4 (33.3%)
Major invasion of wall or retroperitoneum				0.44
No	96 (89.7%)	86 (90.5%)	10 (83.3%)
Yes	11 (10.3%)	9 (9.5%)	2 (16.7%)
Tumor blocks or retractions				0.42
No	89 (83.2%)	80 (84.2%)	9 (75%)
Yes	18 (16.8%)	15 (15.8%)	3 (25%)
Diaphragmatic invasion				0.81
No	96 (89.7%)	85 (89.5%)	11 (91.7%)
Yes	11 (10.3%)	10 (10.5%)	1 (8.3%)

Table 2 Principal Procedures Concerning GIF

	Total	GIF No	GIF Yes	P value
	N=107	N=95 (89%)	N=12 (11%)
Peritonectomy				0.06
No	24 (22.4%)	22 (92%)	2 (8%)
Complete	31 (29%)	24 (77%)	7 (23%)
Partial	52 (48.6%)	49 (94%)	3 (6%)
Fulguration or excision of nodules				0.39
No	57 (53.3%)	52 (91%)	5 (9%)
Yes	50 (46.7%)	43 (86%)	7 (14%)
Visceral resection				0.85
No	20 (18.7%)	18 (90%)	2 (10%)
Yes	87 (81.3%)	77 (89%)	10 (11%)
Bowel resection				0.56
No	25 (23.4%)	23 (92%)	2 (8%)
Yes	82 (76.6%)	72 (88%)	10 (12%)
Type of bowel resection				0.13
No	25 (23.4%)	23 (92%)	2 (8%)
Rectum-Sigmoid	15 (14.0%)	15 (100%)	0
Colon	20 (18.7%)	19 (95%)	1 (5%)
Small bowel	22 (20.6%)	19 (86%)	3 (14%)
Multiple	25 (23.4%)	19 (76%)	6 (24%)
Pancreas and/or spleen resection				0.86
No	78 (72.9%)	69 (89%)	9 (11%)
Yes	29 (27.1%)	26 (90%)	3 (10%)
Number of visceral resections	4±3.1	3±2.8	6±4.1	<0.001
Grouped number of visceral resections				0.07
0–2	44 (41.1%)	42 (96%)	2 (4%)
>2	63 (58.9%)	53 (84%)	10 (16%)
Digestive anastomosis				0.06
No	45 (42.1%)	43 (96%)	2 (4%)
Yes	62 (57.9%)	52 (84%)	10 (16%)
Mean digestive anastomosis per patient	0.9±0.1	0.8±0.1	1.3±0.3	0.13
Grouped number of digestive anastomosis per patient				0.20
0–1	86 (80.4%)	78 (91%)	8 (9%)
>1	21 (19.6%)	17 (81%)	4 (19%)
Definitive stoma				0.99
No	89 (83.2%)	79 (89%)	10 (11%)
Yes	18 (16.8%)	16 (89%)	2 (11%)
Lymphadenectomy				0.76
No	49 (45.8%)	43 (88%)	6 (12%)
Yes	58 (54.2%)	52 (90%)	6 (10%)
Operative bleeding cc	1926±887	1856±893	2483±611	0.02
Grouped operative bleeding cc				0.01
0–1000	17 (15.9%)	17 (100%)	0
1000–2000	57 (53.3%)	53 (93%)	4 (7%)
2000–3000	24 (22.4%)	17 (71%)	7 (29%)
+3000	9 (8.4%)	8 (89%)	1 (11%)
Cytoreduction				0.83
Group A	84 (78.5%)	74 (88%)	10 (12%)
Group B	8 (7.5%)	7 (88%)	1 (12%)
Group C	15 (14%)	14 (93%)	1 (7%)
Cytoreduction				0.54
Group A + B	92 (86%)	81 (88%)	11 (12%)
Group C	15 (14%)	14 (93%)	1 (7%)
Length of stay	22±20.7	19±14.6	49±38.1	<0.001
Grade CLAVIEN-DINDO				<0.001
No complication	50 (46.7%)	50 (100%)	0
I	11 (10.3%)	11 (100%)	0
II	13 (12.1%)	13 (100%)	0
III	27 (25.2%)	17 (63%)	10 (37%)
IV	6 (5.7%)	4 (67%)	2 (33%)
Complication grade				<0.001
No complication	50 (46.7%)	52 (100%)	0
Minor (I–II)	24 (22.4%)	24 (100%)	0
Major (III–IV)	33 (30.9%)	19 (58%)	12 (42%)
Radiologically or endoscopically intervention				<0.001
No	89 (83.2%)	84 (94%)	5 (6%)
Yes	18 (16.8%)	11 (61%)	7 (39%)
Surgical reintervention				<0.001
No	90 (84.1%)	86 (96%)	4 (4%)
Yes	17 (15.9%)	9 (53%)	8 (47%)
90 days mortality				0.002
No	103 (96,3%)	92 (91%)	9 (9%)
Yes	4 (3,7%)	3 (50%)	3 (50%)
Disease recurrence				0.95
No	49 (45.8%)	38 (78%)	5 (22%)
Yes	58 (54.2%)	51 (88%)	7 (12%)
Type of disease recurrence				0.88
Peritoneal	16 (27.6%)	14 (88%)	2 (12%)
Metastases	31 (53.4%)	27 (87%)	4 (13%)
Both	11 (19%)	9 (82%)	2 (18%)

Table 3 The Final Model of Backward-Stepwise Logistic Regression Based on the Variables Associated with Univariate Incidence Risk of GIF

GIF	Odds Ratio	CI 95%	p value
Operative bleeding (mL)	1.01	1.001–1.022	0.016
Partial bowel obstruction	6.26	1.406–27.671	0.015

Table 4 Network Weights Matrix of Correlations

	Charlson	Fistula	PCI	Bleeding	Obstruction
Charlson	–	0.141	−0.067	−0.163	0.137
Fistula	0.141	–	0.322	0.374	0.457
PCI	−0.067	0.322	–	0.221	0.269
Bleeding	−0.163	0.374	0.221	–	−0.039
Obstruction	0.137	0.457	0.269	−0.039	–

Figure 1 Network paths of correlations.

Table 5 Median Survival in Months in Patients with or Without GIF

	Median Survival (Months)	Median CI 95%	Hazard Ratio (GIF vs No GIF)	Hazard Ratio CI 95%
GIF	16	4.6–45.2	2.4	1.33–10.02
No GIF	38	28.6–59.8
Global	34	28.2–45.2

Figure 2 Overall survival according to the existence or absence of GIF.

Figure 3 Disease-free survival according to the existence or absence of GIF.

Figure 4 Overall survival for different types of GIF.

Figure 5 Disease-free survival for different types of GIF.