-
Something wrong with this record ?
Risk factors for anastomotic leakage and its impact on survival outcomes in radical multivisceral surgery for advanced ovarian cancer: an AGO-OVAR.OP3/LION exploratory analysis
F. Trillsch, B. Czogalla, S. Mahner, V. Loidl, A. Reuss, A. du Bois, J. Sehouli, F. Raspagliesi, W. Meier, D. Cibula, A. Mustea, IB. Runnebaum, B. Schmalfeldt, G. Aletti, R. Kimmig, G. Scambia, F. Hilpert, A. Hasenburg, U. Wagner, P. Harter
Language English Country United States
Document type Journal Article, Clinical Trial, Phase III
- MeSH
- Cytoreduction Surgical Procedures * adverse effects MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Lymph Node Excision adverse effects MeSH
- Ovarian Neoplasms * surgery mortality pathology MeSH
- Anastomotic Leak * etiology epidemiology MeSH
- Risk Factors MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
BACKGROUND: Anastomotic leakage is a significant complication following bowel resection in cytoreductive surgery for ovarian cancer. Previous studies have highlighted the detrimental effects of anastomotic leakage on patients' postoperative course. However, there is still a lack of precise identification of the high-risk population and established strategies for preventing its occurrence. MATERIALS AND METHODS: Patients who underwent bowel resection within the surgical phase III trial AGO-OVAR.OP3/LION investigating the impact of systematic pelvic and paraaortic lymphadenectomy in cytoreductive surgery for primary ovarian cancer were included in this analysis. All patients in the AGO-OVAR.OP3/LION trial had undergone complete cytoreduction with no macroscopic residual disease. We analyzed the occurrence of anastomotic leakage regarding surgical procedure (non-lymphadenectomy vs. lymphadenectomy and non-stoma vs. stoma) using the Fisher test. Risk factors for anastomotic leakage and its prognostic impact on survival were analyzed. RESULTS: Overall rate of anastomotic leakage was 7.1%. Notably, the Non-lymphadenectomy subgroup had a lower anastomotic leakage rate of 3.0% compared to the lymphadenectomy subgroup (11.2%, P = 0.005). The use of protective stoma placement resulted in an anastomotic leakage rate of 5.5% regardless of lymphadenectomy compared to the Non-Stoma subgroup (7.5%, P = 0.78). Increased blood loss (odds ratio [OR] 1.04 per 100cc, 95% confidence interval [CI] 1.0001-1.09) and lymphadenectomy (OR 3.67, 95% CI 1.41-11.40) were associated with a higher risk of anastomotic leakage. Although anastomotic leakage demonstrated a numerical detrimental impact on median progression-free survival (PFS) (18 months with anastomotic leakage vs. 19 months with Non-anastomotic leakage, hazard ratio [HR] 0.86; 95% CI 0.5 to 1.4, P = 0.53) and median overall survival (OS) (31 months with anastomotic leakage vs. 58 months with Non-anastomotic leakage, HR 0.69; 95% CI 0.4 to 1.2, P = 0.17), the differences were not statistically significant. CONCLUSION: Anastomotic leakage rates were lower in the Non-lymphadenectomy arm, the current standard of care. Blood loss and lymphadenectomy, as surrogate markers for extensive surgery, were associated with increased risk for anastomotic leakage. These findings highlight the importance of strategies to reduce surgical complexity and perioperative risk to improve clinical outcomes.
Coordinating Center for Clinical Trials Philipps University Marburg Marburg Germany
Department of Gynecologic Oncology European Institute of Oncology University of Milan Italy
Department of Gynecology and Gynecologic Oncology Ev Kliniken Essen Mitte Essen Germany
Department of Gynecology and Gynecological Oncology Bonn University Hospital Bonn Germany
Department of Gynecology and Obstetrics University Hospital Giessen and Marburg Marburg Germany
Department of Gynecology and Obstetrics University of Duisburg Essen Essen Germany
Department of Gynecology Charité Universitätsmedizin Berlin Berlin Germany
Department of Gynecology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Obstetrics and Gynecology Heinrich Heine University Düsseldorf Germany
Department of Obstetrics and Gynecology LMU University Hospital LMU Munich Munich Germany
Gynecologic Oncology Unit Fondazione IRCCS Istituto Nazionale Tumori Milan Italy
Oncologic Medical Center at the Jerusalem Hospital Hamburg Hamburg Germany
University Medical Center Mainz Department of Gynecology and Obstetrics Mainz Germany
References provided by Crossref.org
- 000
- 00000naa a2200000 a 4500
- 001
- bmc25016264
- 003
- CZ-PrNML
- 005
- 20250731091647.0
- 007
- ta
- 008
- 250708s2025 xxu f 000 0|eng||
- 009
- AR
- 024 7_
- $a 10.1097/JS9.0000000000002306 $2 doi
- 035 __
- $a (PubMed)39992106
- 040 __
- $a ABA008 $b cze $d ABA008 $e AACR2
- 041 0_
- $a eng
- 044 __
- $a xxu
- 100 1_
- $a Trillsch, Fabian $u Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany
- 245 10
- $a Risk factors for anastomotic leakage and its impact on survival outcomes in radical multivisceral surgery for advanced ovarian cancer: an AGO-OVAR.OP3/LION exploratory analysis / $c F. Trillsch, B. Czogalla, S. Mahner, V. Loidl, A. Reuss, A. du Bois, J. Sehouli, F. Raspagliesi, W. Meier, D. Cibula, A. Mustea, IB. Runnebaum, B. Schmalfeldt, G. Aletti, R. Kimmig, G. Scambia, F. Hilpert, A. Hasenburg, U. Wagner, P. Harter
- 520 9_
- $a BACKGROUND: Anastomotic leakage is a significant complication following bowel resection in cytoreductive surgery for ovarian cancer. Previous studies have highlighted the detrimental effects of anastomotic leakage on patients' postoperative course. However, there is still a lack of precise identification of the high-risk population and established strategies for preventing its occurrence. MATERIALS AND METHODS: Patients who underwent bowel resection within the surgical phase III trial AGO-OVAR.OP3/LION investigating the impact of systematic pelvic and paraaortic lymphadenectomy in cytoreductive surgery for primary ovarian cancer were included in this analysis. All patients in the AGO-OVAR.OP3/LION trial had undergone complete cytoreduction with no macroscopic residual disease. We analyzed the occurrence of anastomotic leakage regarding surgical procedure (non-lymphadenectomy vs. lymphadenectomy and non-stoma vs. stoma) using the Fisher test. Risk factors for anastomotic leakage and its prognostic impact on survival were analyzed. RESULTS: Overall rate of anastomotic leakage was 7.1%. Notably, the Non-lymphadenectomy subgroup had a lower anastomotic leakage rate of 3.0% compared to the lymphadenectomy subgroup (11.2%, P = 0.005). The use of protective stoma placement resulted in an anastomotic leakage rate of 5.5% regardless of lymphadenectomy compared to the Non-Stoma subgroup (7.5%, P = 0.78). Increased blood loss (odds ratio [OR] 1.04 per 100cc, 95% confidence interval [CI] 1.0001-1.09) and lymphadenectomy (OR 3.67, 95% CI 1.41-11.40) were associated with a higher risk of anastomotic leakage. Although anastomotic leakage demonstrated a numerical detrimental impact on median progression-free survival (PFS) (18 months with anastomotic leakage vs. 19 months with Non-anastomotic leakage, hazard ratio [HR] 0.86; 95% CI 0.5 to 1.4, P = 0.53) and median overall survival (OS) (31 months with anastomotic leakage vs. 58 months with Non-anastomotic leakage, HR 0.69; 95% CI 0.4 to 1.2, P = 0.17), the differences were not statistically significant. CONCLUSION: Anastomotic leakage rates were lower in the Non-lymphadenectomy arm, the current standard of care. Blood loss and lymphadenectomy, as surrogate markers for extensive surgery, were associated with increased risk for anastomotic leakage. These findings highlight the importance of strategies to reduce surgical complexity and perioperative risk to improve clinical outcomes.
- 650 _2
- $a lidé $7 D006801
- 650 _2
- $a ženské pohlaví $7 D005260
- 650 12
- $a netěsnost anastomózy $x etiologie $x epidemiologie $7 D057868
- 650 12
- $a nádory vaječníků $x chirurgie $x mortalita $x patologie $7 D010051
- 650 _2
- $a lidé středního věku $7 D008875
- 650 _2
- $a rizikové faktory $7 D012307
- 650 12
- $a cytoredukční chirurgie $x škodlivé účinky $7 D065426
- 650 _2
- $a lymfadenektomie $x škodlivé účinky $7 D008197
- 650 _2
- $a senioři $7 D000368
- 650 _2
- $a dospělí $7 D000328
- 655 _2
- $a časopisecké články $7 D016428
- 655 _2
- $a klinické zkoušky, fáze III $7 D017428
- 700 1_
- $a Czogalla, Bastian $u Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany
- 700 1_
- $a Mahner, Sven $u Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany
- 700 1_
- $a Loidl, Verena $u Faculty of Medicine, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- 700 1_
- $a Reuss, Alexander $u Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Germany
- 700 1_
- $a du Bois, Andreas $u Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- 700 1_
- $a Sehouli, Jalid $u Department of Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- 700 1_
- $a Raspagliesi, Francesco $u Gynecologic Oncology Unit Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- 700 1_
- $a Meier, Werner $u Department of Obstetrics and Gynecology, Heinrich-Heine-University Düsseldorf, Germany
- 700 1_
- $a Cibula, David $u Department of Obstetrics, Gynaecology and Neonatology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Czech Republic
- 700 1_
- $a Mustea, Alexander $u Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
- 700 1_
- $a Runnebaum, Ingo B $u Department of Gynecology and Reproductive Medicine and Center for Gynecologic Oncology, Jena University Hospital, Jena, Germany
- 700 1_
- $a Schmalfeldt, Barbara $u Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 700 1_
- $a Aletti, Giovanni $u Department of Gynecologic Oncology, European Institute of Oncology, University of Milan, Italy
- 700 1_
- $a Kimmig, Rainer $u Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
- 700 1_
- $a Scambia, Giovanni $u Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del S. Cuore Rome, Rome, Italy
- 700 1_
- $a Hilpert, Felix $u Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
- 700 1_
- $a Hasenburg, Annette $u University Medical Center Mainz, Department of Gynecology and Obstetrics, Mainz, Germany
- 700 1_
- $a Wagner, Uwe $u Department of Gynecology and Obstetrics, University Hospital Giessen and Marburg, Marburg, Germany
- 700 1_
- $a Harter, Philipp $u Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany $u Department of Gynecology and Obstetrics, University Hospital Giessen and Marburg, Marburg, Germany
- 773 0_
- $w MED00166846 $t International journal of surgery $x 1743-9159 $g Roč. 111, č. 4 (2025), s. 2914-2922
- 856 41
- $u https://pubmed.ncbi.nlm.nih.gov/39992106 $y Pubmed
- 910 __
- $a ABA008 $b sig $c sign $y - $z 0
- 990 __
- $a 20250708 $b ABA008
- 991 __
- $a 20250731091641 $b ABA008
- 999 __
- $a ok $b bmc $g 2366839 $s 1253389
- BAS __
- $a 3
- BAS __
- $a PreBMC-MEDLINE
- BMC __
- $a 2025 $b 111 $c 4 $d 2914-2922 $e 20250401 $i 1743-9159 $m International journal of surgery $n Int J Surg $x MED00166846
- LZP __
- $a Pubmed-20250708
