Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial

Kondalsamy-Chennakesavan, Srinivas, Gebski, Val, Janda, Monika, Baker, Jannah, Brand, Alison, Hogg, Russell, Jobling, Thomas W., Land, Russell, Manolitsas, Thomas, Nascimento, Marcelo, Neesham, Deborah, Nicklin, James, Oehler, Martin K., Otton, Geoff, Perrin, Lewis, Salfinger, Stuart, Hammond, Ian, Leung, Yee, Sykes, Peter, Ngan, Hextan, Garrett, Andrea, Laney, Michael, Ng, Tong Yow, Tam, Karfai, Chan, Karen, Wrede, David H., Pather, Selvan, Simcock, Bryony, Farrell, Rhonda, Roberstson, Gregory, Walker, Graeme, McCartney, Anthony, & Obermair, Andreas (2012) Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial. European Journal of Cancer, 48(14), pp. 2155-2162.

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Aims: To identify risk factors for major Adverse Events (AEs) and to develop a nomogram to predict the probability of such AEs in individual patients who have surgery for apparent early stage endometrial cancer.

Methods: We used data from 753 patients who were randomized to either total laparoscopic hysterectomy or total abdominal hysterectomy in the LACE trial. Serious adverse events that prolonged hospital stay or postoperative adverse events (using common terminology criteria 3+, CTCAE V3) were considered major AEs. We analyzed pre-surgical characteristics that were associated with the risk of developing major AEs by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The six most significant or clinically important variables were included in the nomogram to predict the risk of major AEs within 6 weeks of surgery and the nomogram was internally validated.

Results: Overall, 132 (17.5%) patients had at least one major AE. An open surgical approach (laparotomy), higher Charlson’s medical co-morbidities score, moderately differentiated tumours on curettings, higher baseline ECOG score, higher body mass index and low haemoglobin levels were associated with AE and were used in the nomogram. The bootstrap corrected concordance index of the nomogram was 0.63 and it showed good calibration.

Conclusions: Six pre-surgical factors independently predicted the risk of major AEs. This research might form the basis to develop risk reduction strategies to minimize the risk of AEs among patients undergoing surgery for apparent early stage endometrial cancer.

Impact and interest:

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ID Code: 54696
Item Type: Journal Article
Refereed: Yes
Keywords: surgical adverse events, open surgery, laparoscopic surgery, early stage endometrial cancer, randomised controlled trial
DOI: 10.1016/j.ejca.2012.03.013
ISSN: 0959-8049
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2012 Elsevier
Copyright Statement: This is the author’s version of a work that was accepted for publication in European Journal of Cancer. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in European Journal of Cancer, [VOL 48, ISSUE 14, (2012)] DOI: 10.1016/j.ejca.2012.03.013
Deposited On: 11 Nov 2012 23:50
Last Modified: 13 Nov 2012 05:18

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