Preoperative quality of life as prediction for severe postoperative complications in gynecological cancer surgery: results of a prospective study

Arch Gynecol Obstet. 2021 Apr;303(4):1057-1063. doi: 10.1007/s00404-020-05847-1. Epub 2020 Oct 29.


Purpose: The aim of this study was to investigate preoperative quality of life (QoL) as a predictive tool for severe postoperative complications (POC) in gynecological cancer surgery.

Methods: This is a prospective study of patients undergoing gynecologic cancer surgery at an academic center in Germany. QoL was assessed by the EORTC Quality of Life Questionnaire (QLQ-C30) and the NCCN Distress Thermometer (DT). Several geriatric assessment tools have been applied. POC were graded using Clavien-Dindo criteria. Using multivariable logistic regression models, we identified predictive clinical characteristics for postoperative complications.

Results: Within 30 days of surgery, 40 patients (18%) experienced grade ≥ 3b complications including 9 patients (4%) who died. The dominant complication was anastomosis insufficiency with 13 patients (5.8%). In the multivariable stepwise logistic regression through all univariate significant variables, we found that impaired physical functioning was predictive of POC, defined by an EORTC score < 70 (OR 5.08, 95% CI 2.23-11.59, p < 0.001). Regarding symptoms nausea/vomiting assessed as an EORTC score > 20 (OR 3.08, 95% CI 1.15-8.26, p = 0.025) indicated a significant predictive value. Being overweight or obese (BMI > 25) were also identified as predictive factors (OR 5.44, 95% CI 2.04-14.49, p = 0.001) as were reduced Mini Mental State Examination (MMSE) results < 27 (OR 7.94, 95% CI 1.36-45.46, p = 0.02).

Conclusion: Preoperative QoL measurements could help to predict postoperative complications in patients with gynecological cancer. Patients with limitations of mobility, debilitating symptoms and cognitive impairment have an increased risk for developing severe POC.

Keywords: Gynecology; Oncology; Postoperative complications; Quality of life (QoL); Surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Genital Neoplasms, Female / psychology
  • Genital Neoplasms, Female / surgery*
  • Germany
  • Gynecologic Surgical Procedures
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Preoperative Period
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires
  • Young Adult