Association of surgical complexity with patient-reported outcomes among patients with ovarian cancer

To determine the association of surgical complexity with patient-reported outcomes (PROs) following ovarian cancer debulking surgery.

Patients who underwent debulking surgery for ovarian cancer from 01/2016-12/2023 were reviewed. Patients completed the EORTC QLQ-C30 or QLQ-OV28 measures preoperatively and at least once after surgery at 30, 90, 180, or 365 days, with opportunities to complete measures at all timepoints. The Aletti surgical complexity score categorized low- from high-complexity surgery. Multivariable linear mixed models examined longitudinal associations of surgical complexity with PROs over time. The QLQ-30 Symptom, QLQ-30 Functional, and OV28 scales were analyzed separately.

Of 328 patients analyzed, the mean age was 65.5 (SD 12.5) years, and 222 (67.7%) patients received either neoadjuvant or adjuvant chemotherapy. 96 (29.3%) patients had Aletti scores ≥4 and were categorized as high complexity. Patients reported decreased symptom burden on the QLQ-C30 scales at 365 days compared to preoperatively (adjusted mean difference [aMD] -4.8, p < 0.001), which did not differ by surgical complexity over time. Patients reported improved functioning on the QLQ-C30 functioning scales at 365 days compared to preoperatively (aMD 6.2, p < 0.001), which differed by surgical complexity at 30 days (aMD -7.3, p < 0.01) but not at 365 (aMD -2.9, p > 0.05). Patients reported improved ovarian cancer-specific concerns on the QLQ-OV28 at 365 days compared to preoperatively (aMD -5.0, p < 0.001), which did not differ by surgical complexity over time.

Complex surgery, when clinically warranted, is appropriate from a health-related quality of life perspective. These data offer an opportunity for more patient-centered, evidence-based counseling.