Die Rolle des Faktor XIII-Mangels bei der Operation von Patientinnen mit fortgeschrittenem Ovarialkarzinom und andere Risikofaktoren der Primäroperation

This cumulative dissertation comprises two publications on the topic of risk factors of primary debulking surgery in patients with advanced ovarian cancer. The focus of the first retrospective original work (The role of factor XIII in the context of surgery for advanced ovarian cancer) is on coagulation factor XIII and its effects on the perioperative course, especially on postoperative complications, in the case of preoperative deficiency of this factor in serum. Patients with large amounts of ascites, advanced stages of the disease and several concomitant diseases require very sophisticated coagulation management. In the Essen-Mitte clinics, an accumulation of FXIII deficiency was noticed in patients with ovarian cancer, so that the determination of the factor is now routine and is being investigated in our first study (The role of factor XIII in surgery for advanced stage of epithelial ovarian cancer) with regard to its role in perioperative complications as well as survival. Our results indicate that FXIII deficiency is a common phenomenon in this patient population. It most likely correlates with advanced disease based on our results. Patients with moderate or severe FXIII deficiency are significantly more likely to suffer from higher levels of ascites, are more likely to show higher CA-125 levels as well as hypalbuminemia. The operations in the FXIII deficiency group lasted longer and were more complication-prone (higher blood loss, more frequent incomplete resections). FXIII deficiency independently and significantly increases the likelihood of serious postoperative complications. For example, thromboembolic events and cardiovascular complications occurred almost twice as often in patients with moderate and severe FXIII deficiency than in those with normal FXIII. An independent influence of FXIII deficiency on overall survival was not shown. The second (planned) publication (Ovarian cancer: risk factors for postoperative complications in epithelial ovarian cancer) is a literature review with the aim of comprehensively considering any risk factors for primary surgery in patients with ovarian cancer and thus contributing to the optimal therapy strategy. The factors age >75 years, obesity, frailty, a high ACCI score, high ascites levels, FXIII deficiency, hypalbuminemia and a preoperative thrombocytosis and leukocytosis are associated with an increased complication rate. The influence of the variables also analysed here (sarcopenia, tumour histology, nicotine abuse, other specific comorbidities, FIGO stage and quality of life) will only become sufficiently visible with further research data. Both works pursue the goal of optimising the therapy strategy through knowledge of operative risk factors.