{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:53:48Z","timestamp":1760057628696,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,16]],"date-time":"2025-02-16T00:00:00Z","timestamp":1739664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ovarian cancer surgery requires multiple radical resections with a high risk of complications. The objective of this single-centre, retrospective study was to identify the factors associated with pulmonary complications following cytoreduction. Methods: The study included 179 patients who underwent surgery at the gynaecological oncology department of the Antalya Training and Research Hospital between January 2015 and December 2021. A univariate analysis was performed to identify significant risk factors for postoperative pulmonary complications. The data obtained were then subjected to multivariate analysis to determine the relative importance of each factor. Results: A total of 176 ovarian cancer patients underwent cytoreductive surgical procedures for epithelial ovarian cancer (EOC) during the study period. Postoperative pulmonary complications (PPCs) occurred in a total of 24 patients (13.4%). Of the complications observed, n = 18 (10.06%) were pulmonary effusion, n = 5 (2.79%) were pulmonary thromboembolism, n = 1 (0.56%) was pneumo-mediastinum, n = 6 (3.35%) were pulmonary oedema, and n = 1 (0.56%) was transfusion-related lung injury (TRALI). Pulmonary complication rates were 6.512 times higher in patients who underwent diaphragm peritonectomy (p = 0.014) and 26.1 times higher in smokers (p = 0.005). When an ROC analysis was performed for quantitative parameters related to pulmonary complications, the sensitivity and specificity of the duration of surgery were 83.3% and 64.5%, respectively, and the sensitivity and specificity of the duration of postoperative hospital stay were 79.2% and 67.5% (p &lt; 0.001, p &lt; 0.001, p &lt; 0.001, p &lt; 0.001). Conclusions: An improved understanding of the multifactorial aetiology of PPCs and the development of an appropriate perioperative management strategy may serve to mitigate the negative impact of these complications, thereby contributing to an enhancement in patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm14041314","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T03:41:47Z","timestamp":1739763707000},"page":"1314","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Factors Associated with Pulmonary Complications in Patients Undergoing Surgery for Epithelial Ovarian Cancer"],"prefix":"10.3390","volume":"14","author":[{"given":"Aysun","family":"Alci","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Necim","family":"Yalcin","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Gokkaya","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2618-7603","authenticated-orcid":false,"given":"Gulsum","family":"Ekin Sari","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5866-600X","authenticated-orcid":false,"given":"Harun","family":"Turkmenoglu","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulku","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isin","family":"Ureyen","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6706-6915","authenticated-orcid":false,"given":"Tayfun","family":"Toptas","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Antalya Training and Research Hospital, Health Sciences University, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21551","article-title":"Cancer statistics","volume":"69","author":"Siegel","year":"2019","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1097\/IGC.0000000000000074","article-title":"ATL","volume":"24","author":"Tanizaki","year":"2014","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Di Donato, V., Caruso, G., Golia D\u2019Aug\u00e8, T., Perniola, G., Palaia, I., Tomao, F., Muzii, L., Pernazza, A., Della Rocca, C., and Bogani, G. (2024). Prognostic Impact of Microscopic Residual Disease After Neoadjuvant Chemotherapy in Patients Undergoing Interval Debulking Surgery for Advanced Ovarian Cancer. Arch. Gynecol. Obstet.","DOI":"10.1007\/s00404-024-07775-w"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1016\/j.ygyno.2008.07.053","article-title":"Upper abdominal surgical procedures: Liver mobilization and diaphragm peritonectomy\/resection, splenectomy, and distal pancreatectomy","volume":"111","author":"Kehoe","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1245\/s10434-020-08989-3","article-title":"Hepatobiliary disease resection in patients with advanced epithelial ovarian cancer: Prognostic role and optimal cytoreduction","volume":"28","author":"Giannini","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.ygyno.2017.06.007","article-title":"The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery","volume":"146","author":"Grimm","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_7","first-page":"408","article-title":"Surgical techniques for diaphragmatic resection during cytoreduction in advanced or recurrent ovarian carcinoma: A systematic Review and meta-analysis","volume":"25","author":"Bogani","year":"2015","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ye, S., He, T., Liang, S., Chen, X., Wu, X., Yang, H., and Xiang, L. (2017). Diaphragmatic surgery and related complications in primary cytoreduction for advanced ovarian, tubal, and peritoneal carcinoma. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3311-8"},{"key":"ref_9","first-page":"e30975","article-title":"Incidence and risk factors of postoperative complications in general surgery patients","volume":"14","author":"Dharap","year":"2022","journal-title":"Cureus"},{"key":"ref_10","unstructured":"Hobson, B., Liu, D.Y.-M., Hadjipavlou, D.N., and Stephens, R.C.M. (2016). An Introduction to Postoperative Complications. [Bachelor\u2019s Thesis, University College London]. Available online: https:\/\/www.ucl.ac.uk\/anaesthesia\/StudentsandTrainees\/Intro_to_postop_Complications."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Xu, M., Zhang, W., Gao, C., Zhou, Y., and Xie, Y. (2022). Postoperative pulmonary complications and outcomes in cytoreductive surgery for ovarian cancer: A propensity-matched analysis. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01660-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative pulmonary complications","volume":"118","author":"Miskovic","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1001\/jamasurg.2016.4065","article-title":"Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators","volume":"152","author":"Frendl","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"599","DOI":"10.4103\/0019-5049.165857","article-title":"Post-operative pulmonary complications after non-cardiothoracic surgery","volume":"59","author":"Kelkar","year":"2015","journal-title":"Indian J. Anaesth."},{"key":"ref_15","first-page":"002","article-title":"Perioperative Lung Protective Strategies","volume":"S2","author":"Licker","year":"2012","journal-title":"J. Pulmonar Respirat. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1136\/ijgc-2020-001640","article-title":"Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850)","volume":"30","author":"Fagotti","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3191","DOI":"10.1016\/j.ejca.2013.06.013","article-title":"Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial","volume":"49","author":"Tajik","year":"2013","journal-title":"Eur. J. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/ijgo.12614","article-title":"Cancer of the ovary, fallopian tube, and peritoneum","volume":"143","author":"Berek","year":"2018","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_20","unstructured":"Barash, P.G., Cullen, B.F., Stoelting, R.K., Cahalan, M.K., and Stock, C.M. (2009). Clinical Anesthesia, Lippincott Williams & Wilkins."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.ygyno.2004.04.032","article-title":"Diaphragm resection for ovarian cancer: Technique and short-term complications","volume":"94","author":"Cliby","year":"2004","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/BF02602761","article-title":"Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery","volume":"10","author":"Lawrence","year":"1995","journal-title":"J. Gen. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1378\/chest.99.4.923","article-title":"A multivariate analysis of the risk of pulmonary complications after laparotomy","volume":"99","author":"Hall","year":"1991","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1378\/chest.111.3.564","article-title":"Predictors of postoperative pulmonary complications following abdominal surgery","volume":"111","year":"1997","journal-title":"Chest"},{"key":"ref_25","first-page":"1144","article-title":"Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: Analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique","volume":"106","author":"Kusamura","year":"2006","journal-title":"Cancer Interdiscip. Int. J. Am. Cancer Soc."},{"key":"ref_26","first-page":"635314","article-title":"Pulmonary complications following cytoreductive surgery and perioperative chemotherapy in 147 consecutive patients","volume":"1","author":"Preti","year":"2012","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0025-6196(12)65337-3","article-title":"Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: A blinded prospective study of coronary artery bypass patients","volume":"64","author":"Warner","year":"1989","journal-title":"Mayo Clin. Proc."},{"key":"ref_28","unstructured":"Jyotsna, A., Gupta, N., and Paul, A.K. (2024). Stoelting\u2019s Anesthesia and Co-Existing Disease, Elsevier Health Sciences."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/00000542-198411000-00018","article-title":"Smoking and anesthesia: Preoperative abstinence and perioperative morbidity","volume":"61","author":"Pearce","year":"1984","journal-title":"Anesthesiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1007\/s13193-021-01438-x","article-title":"Complications and outcomes of diaphragm surgeries in epithelial ovarian malignancies","volume":"12","author":"Datta","year":"2021","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sand, O., Andersson, M., Arakelian, E., Cashin, P., Semenas, E., and Graf, W. (2021). Severe pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are common and contribute to decreased overall survival. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0261852"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1515\/pp-2022-0203","article-title":"Early postoperative CRP predicts major complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)","volume":"8","author":"Kartik","year":"2023","journal-title":"Pleura Peritoneum"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1314\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:35:44Z","timestamp":1760027744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,16]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041314"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041314","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,2,16]]}}}