Predictors of postoperative morbidity after debulking surgeries for gynecological malignancies

Gynecological malignancies, particularly ovarian and endometrial cancers, primarily contribute to cancer-related morbidity and mortality across the world and in India. Debulking surgery is still the cornerstone of treatment for advanced cases, but these procedures are associated with significant perioperative risks that can impact recovery and delay adjuvant therapy.

This study intends to identify predictors of 30-day postoperative morbidity and 90-day mortality following debulking surgeries for gynecological malignancies in an Indian tertiary care setting.

A retrospective observational study was conducted at the National Cancer Institute, AIIMS Jhajjar, including 100 patients who underwent debulking surgery for ovarian, endometrial, or cervical malignancies between January 2022 and June 2023. Data on demographics, disease stage, surgical details, intraoperative events, and postoperative outcomes were collected. Univariate and multivariable logistic regression analyses were performed to identify significant predictors of morbidity and mortality.

Major 30-day morbidity occurred in 42% of patients, while no 90-day mortality was noted. On univariate analysis, surgical duration >300 min (odds ratio (OR) 2.72[95% confidence interval {CI} 1.15 to 6.44]; P = 0.021), sustained hypotension (OR 2.67[95% CI 1.05 to 6.75]; P = 0.035), blood loss ≥500 ml (OR 2.56[95% CI 1.11 to 5.89]; P = 0.025), and intraoperative blood transfusion (OR 3.70[95% CI 1.60 to 8.53]; P = 0.002) were significantly associated with increased morbidity. Multivariable analysis revealed that intermediate or high surgical complexity was protective against 30-day morbidity (OR 0.163 [95% CI 0.034 to 0.792]; P = 0.025), which can be attributed to careful patient selection and better perioperative optimization of high-risk patients.

Prolonged surgery, increased blood loss, and hemodynamic instability are decisive predictors of postoperative morbidity. Selection and perioperative optimization enable safe performance of complex debulking procedures in appropriate patients. Employing structured risk stratification and targeted perioperative interventions is essential for improving postoperative outcomes in this population. Prospective validation and assessment of these strategies should be emphasized.