Team-based care may lower anastomotic leak rate and improve outcomes during ovarian cancer cytoreductive surgery: JAMA

Extensive bowel surgery is often necessary to achieve complete cytoreduction in epithelial ovarian cancer patients. While bowel resections are high-risk procedures that result in complications related to anastomotic leaks, it remains unclear if the type of surgeon performing the operation impacts the outcome for the patient. This study aimed to compare surgical outcomes between a gynecologic oncologist, a general surgeon, and a two-surgeon team approach in this population.

This is a retrospective cohort study comparing surgical outcomes for gynecologic oncologists, general surgeons, and a two-surgeon team approach in patients with advanced epithelial ovarian cancer who underwent bowel surgery during cytoreductive debulking.

This study utilized the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) datasets from 2012 through 2020. The data were analyzed from March 2022 to March 2023 and reanalyzed in May 2024 for quality assurance. The analysis included cytoreductive surgeries performed by gynecologic oncologists, general surgeons, or a two-surgeon team approach for patients with ovarian cancer recorded in the NSQIP datasets. The two-surgeon team approach involved any combination of the mentioned surgical specialties. The primary outcome of interest was the anastomotic leak rate following bowel surgery during ovarian cancer debulking.

Results

• A total of 1810 patients were included in the study. In the general surgery cohort, the mean (SD) patient age was 65.1 (11.1) years and the mean (SD) body mass index (BMI) was 26.9 (7.4).

• In the gynecologic oncology cohort, the mean (SD) patient age was 63.5 (11.7) years and the mean (SD) BMI was 27.7 (6.5). In the two-surgeon team cohort, the mean (SD) patient age was 62.4 (12.1) years and the mean (SD) BMI was 28.1 (7.0).

• Gynecologic oncologists performed 1217 cases (67.2%), general surgeons performed 97 cases (5.4%), and 496 cases (27.4%) involved two-surgeon teams.

• Bivariate analysis revealed an anastomotic leak rate of 3.6% for gynecologic oncologists, 5.2% for general surgeons, and 0.4% for cases with two surgical teams (P < .001).

• Multivariable analysis showed an adjusted odds ratio for anastomotic leak of 1.53 (95% CI, 0.59-3.96) for the general surgeon group (P = .38) compared to an adjusted odds ratio of 0.11 (95% CI, 0.03-0.47) for the two-surgeon team approach (P = .003), with the referent being gynecologic oncology.

Results from the study confirm that the anastomotic leak rate is lower with two surgeons operating, regardless of specialty. This outcome thus supports the view of team-based surgical care improving bowel surgery outcomes during ovarian cancer debulking. The results suggest that collaboration between surgical specialists enhances patient safety and reduces complications.

In this study, the anastomotic leak rate was significantly lower when two surgeons participated in bowel surgery for advanced epithelial ovarian cancer. These results support the implementation of a team-based approach in surgical practice to improve patient outcomes.

Reference:

Ebott, J., Has, P., Raker, C., & Robison, K. (2024). Bowel resection outcomes in ovarian cancer cytoreductive surgery by surgeon specialty. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.2924