Surgeon Type and Anastomotic Leaks in Ovarian Cancer
Menée à partir de données 2012-2020 portant sur 1 810 patientes atteintes d'un cancer épithélial de l'ovaire (âge moyen : 62-65 ans), cette étude analyse le taux de fuite anastomotique lors d'une cytoréduction complète avec chirurgie intestinale extensive, en fonction du type de chirurgien réalisant l'acte (gynécologue oncologue, chirurgien général ou équipe de deux chirurgiens)
For patients with advanced ovarian cancer, cytoreductive surgery (CRS) and platinum-based chemotherapy are pillars of treatment. Optimal completeness of cytoreduction, which may necessitate multivisceral resections, aims to achieve minimal residual disease and improve oncologic outcomes.Ebott et al used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to explore whether postoperative complication rates differ between gynecological oncologists and general surgeons after bowel resection during CRS for ovarian cancer. They also investigated whether multisurgeon teams were associated with fewer postoperative complications. They found no significant differences in surgical outcomes between surgeon specialties. However, multivariate analysis adjusting for race, ethnicity, and the presence of ascites revealed that 2-surgeon teams had lower odds of anastomotic leak (adjusted odds ratio, 0.11, 95% CI, 0.03-0.47). Although pairwise comparisons and predictive analyses were not conducted, it was presumed that 2-surgeon teams also had lower rates of return to the operating room. While clinically important confounders such as level of bowel resection and anastomosis (eg, small bowel vs colorectal), extent of disease, completeness of cytoreduction, and diversion were not accounted for, these findings raise important questions about safe approaches to complex cytoreductive procedures.