Outcome at second-look laparotomy: anaesthesia related risk factors

To identify anaesthesia related risk factors associated with positive second-look laparotomy (SLL) findings in patients with epithelial ovarian carcinoma who had previous optimal cytoreduction surgery under general anaesthesia.

A retrospective review of the anaesthesia and medical records of patients with epithelial ovarian cancer who underwent SLL at our institution and analysis of patient related (age, haemoglobin, albumin), anaesthesia related (duration of anaesthesia, anaesthetics and dosages, transfusion of blood products), tumour related (stage, grade, presence of ascites, adhesion, histological type, capsule penetration and CA-125) data and outcome of SLL was undertaken.

The patients had SLL 305 +/- 215 days after the first operation. Of the 83 patients 28 (33.7%) were SLL (+). SLL (+) patients were significantly more likely to have a mucinous histological subtype, required intraoperative packed red blood cell (PRBC) transfusion and longer anaesthesia duration (p < 0.05). Type of induction agent, whether narcotics were used or not, type of volatile agent used, dosages of induction agents and dosages of narcotic and muscle relaxants did not vary significantly between the patients with and without cancer recurrence (p > 0.05). Duration of anaesthesia (OR, 1.03; CI, 1-1.05, p = 0.031) and histological subtype (OR, 16.1; CI, 1.8-141.7, p = 0.012), were the independent variables predicting cancer recurrence in the multivariate logistic regression.

We emphasize that duration of anaesthesia and histological subtype are risk factors for cancer recurrence in early stage ovarian carcinoma. From our data it seems that interventions to shorten the duration of general anaesthesia or reversing immunosuppression induced by anaesthesia and surgery must be carefully considered.