Abstract
INTRODUCTION: Surgery is the cornerstone of ovarian cancer treatment. However, surgery and perioperative inflammation have been described as potentially pro-metastagenic. In various animal models and other human cancers, intraoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) appears to have a positive impact on patient outcomes.
MATERIALS AND METHODS: In this unicentric retrospective study, we provide an exploratory analysis of the safety and potential benefit of intraoperative administration of ketorolac on the outcome of patients undergoing surgery for ovarian cancer. The study population included all patients who were given a diagnosis of ovarian, fallopian tube or peritoneal cancer by the multidisciplinary oncology committee (MOC) of the Cliniques universitaires Saint-Luc between 2015 and 2020.
RESULTS: We included 166 patients in our analyses, with a median follow-up of 21.8 months. Both progression-free survival and overall survival were superior in patients who received an intraoperative injection of ketorolac (34.4 months of progression-free survival in the ketorolac group versus 21.5 months in the non-ketorolac group ( p = 0.002), and median overall survival was not reached in either group but there was significantly higher survival in the ketorolac group ( p = 0.004)). We also performed subgroup analyses to minimise bias due to imbalance between groups on factors that could influence patient survival, and the group of patients receiving ketorolac systematically showed a better outcome. Uni- and multivariate analyses confirmed that administration of ketorolac intraoperatively was associated with better progression-free survival (HR = 0.47 on univariate analysis and 0.43 on multivariate analysis, p = 0.003 and 0.023, respectively). In terms of complications, there were no differences between the two groups, either intraoperatively or postoperatively.
CONCLUSION: Our study has shown a favourable association between the use of ketorolac during surgery and the postoperative progression of ovarian cancer in a group of 166 patients, without any rise in intra- or postoperative complications. These encouraging results point to the need for a prospective study to confirm the benefit of intraoperative administration of ketorolac in ovarian cancer surgery.
Original language | English |
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Article number | 1546 |
Number of pages | 20 |
Journal | Journal of Clinical Medicine |
Volume | 13 |
Issue number | 6 |
Early online date | 7 Mar 2024 |
DOIs | |
Publication status | Published - 7 Mar 2024 |
Bibliographical note
The authors want to thank Laurence Beausaert and Monique Kasa-Vubu, coordinating nurses of gynaecological oncology, Magali Alsteen and Véronique Delhaye for the recording of the data and all the nurses from the operating theatre and the hospitalisation unit (U95) of the cliniques universitaire St Luc. We also want to thank the intensive care unit team for the care of our patients.Data Availability Statement
All the data are kept by the first authors of the paper.Keywords
- ovarian cancer
- oncological surgery
- peri operative inflammation
- NSAID