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2011) and the Predictive Value Score (PVS) nine criteria (Suidan,

Gyn Onc 2014) to predict the risk of suboptimal debulking. Accuracy

was dened as the percentage of total patients correctly identied

for their surgical outcome.

Results:The optimal debulking rate in our cohort was 71% and the

successful surgery rate (optimal debulking and no major complica-

tion) was 68%. A SRS score of N=2 predicted unsuccessful surgery

with 78% accuracy (sensitivity 53%, specicity 90%, PPV 71%, NPV

80%) in our cohort. Using the SRS model, 24% of patients would havetriaged to neoadjuvant chemotherapy, and only 15 of 76 patients

selected for debulking surgery would have either had suboptimal

debulking or a major peri-operative complication. A NN score of

N=88 (associated with N50% chance of suboptimal debulking),

predicted suboptimal debulking with 57% accuracy (sensitivity 90%,

specicity 44%, PPV 39%, NPV 91%). However, using the NN model, 66%

of the patients in the current cohort would have been triaged to

neoadjuvant chemotherapy and 40 of these 66 patients would have

actually had optimal debulking. A PVS score of N=7 (associated

with N50% chance of suboptimal debulking), gave accuracy of 73%

(sensitivity 24%, specicity 93%, PPV 58%, NPV 75%). Twenty-ve

percent (22/88) of patients would have been incorrectly identied to

have optimal debulking using the PVS in our cohort. When separated

into categories based on predictive score,the SRSwas most predictive of

unsuccessful surgery in the highest score groups.

Conclusions:Prediction models for suboptimal debulking or a major

surgical complication could be used to triage patients with advanced

ovarian, fallopian tube and primary peritoneal cancer to primary

cytoreductive surgery or neoadjuvant chemotherapy. In our cohort of

patients, the SRS maintained the highest accuracy rate compared to

the NN and PVS models. Additional assessment of the Surgical Risk

Score (SRS) model is warranted.

doi:10.1016/j.ygyno.2015.03.036

Session II: Molecular Pathology

Moderator: Chris Crum, MD,Brigham and Womens Hospital, Boston, MA

Making the case for salpingectomy as the elective sterilization

procedure: A decision analysis

S. Dilleya, A. Allena, C. Lessard-Andersonb, J. Bakkum-Gamezc,

Koenraad De Geesta, A.B. Caugheya, M.I. Rodrigueza. aOregon Health &

Science University, Department of Obstetrics and Gynecology, Portland, OR,

United States, bAltru Health System, Department of Obstetrics and

Gynecology, Grand Forks, ND, United States, cMayo Clinic, Department

of Obstetrics and Gynecology, Rochester, MN, United States

Objectives:Female sterilization is one of the most commonly used

contraceptive methods in the United States, and laparoscopic tubal

occlusion with a clip or ring has been the primary method forinterval sterilization. With recent data showing the Fallopian tube as

a source of epithelial ovarian cancer (EOC), many providers have

begun routinely recommending salpingectomy in low risk women

requesting tubal sterilization. However, little is known about

the actual increased risks, and potential benets, of a policy of

routine salpingectomy compared to the standard practice of tubal

occlusion. Furthermore, the EOC risk-reducing benets of excisional

salpingectomy are currently theoretical, with limited data suggesting

that excision of the tubes confers a decreased risk of EOC compared

with other methods. Our objective was to compare the risks and

benets of routine salpingectomy with occlusive methods at the time

of interval laparoscopic sterilization in order to provide gynecologic

surgeons with guidance when counseling their patients desiring

permanent contraception.

Methods: We built a decision-analytic model to compare the

difference in cases of ovarian cancer prevented, cancer deaths

prevented, unintended pregnancies averted and total quality-

adjusted life years (QALYs) gained with a policy of routine

salpingectomy compared with tubal occlusion. The study population

is women aged 35 who request laparoscopic sterilization. A Markov

model accounts for the annual risk of developing EOC over a 30-year

time horizon. SEER cancer registry data was used for age-specicrisks of EOC. The risk reductions associated with different types

of tubal sterilization were obtained from the literature. We obtained

probabilities for rates of surgical complications, contraceptive

failure, and utilities for ovarian cancer and unintended pregnancy

from the literature.

Results: For every 300,000 women who receive laparoscopic

salpingectomy instead of sterilization with an occlusive method, 216

unintended pregnancies, 1230 cases of EOC and 1200 deaths from EOC

would be averted over 30 years. This practice would result in an

increase of 25,359 QALYs over the same time period. Sensitivity

analyses were run in order to conrm the validity of our assumptions.

Even if we assume a threefold greater risk of surgical complications,

routine salpingectomy yields increased QALYs compared with TO,

as long as salpingectomy reduces the risk of EOC by at least 5%.Conclusions: Among low risk women requesting tubal sterilization,

routine salpingectomy prevents EOC cases and deaths, averts unintended

pregnancies and improves QALYs compared with tubal occlusive

methods. Future research is needed to ascertain the precise impact on

ovarian cancer provided by salpingectomy.

doi:10.1016/j.ygyno.2015.03.037

Session III: Rare Tumors

Moderator: Jubilee Brown, MD,

The University of Texas, MD Anderson Cancer Center, Houston, TX

Effect of preoperative chemotherapy on postoperative morbidity

and mortality in patients undergoing surgery for ovarian cancer

D. Dooa, M. Guyb, K. Behbakhtb, S. Davidsonb, J. Sheedera, S. Guntupallib.aUniversity of Colorado, Department of Obstetrics and Gynecology, Aurora,

CO, United States, bUniversity of Colorado, Department of Obstetrics and

Gynecology, Division of Gynecologic Oncology, Aurora, CO, United States

Objectives: Neoadjuvant chemotherapy in the treatment of ovarian

cancer is increasing. We sought to determine if there is an

association between pre-operative chemotherapy and post-operative

morbidity and mortality in ovarian cancer patients undergoing

surgical debulking.

Methods: The American College of Surgeons National Surgical

Quality Improvement Program database was used to identify womenundergoing surgical debulking for ovarian cancer between 2005 and

2012. Women who had received chemotherapy 30 days prior to

surgery were compared to those who did not. Baseline characteris-

tics, total operative time, length of stay, post-operative morbidity,

and mortality were compared between groups. Standard statistical

analyses were used.

Results: One thousand eight hundred seven cases were identied

and 195 (10.8%) received chemotherapy 30 days prior to surgery.

The preoperative chemotherapy group was more likely to have used

steroids within 30 days prior to surgery (4.6 vs 2.0%, p = 0.02), was

more likely to have lost N10% of their body weight in the 6 months

prior to surgery (10.3 vs 5.2%, p b 0.01), and was more likely to have

a bleeding disorder (9.7 vs 3.3%, p b 0.01). Patients who received

chemotherapy also entered surgery with lower platelets (250 106

Abstracts / Gynecologic Oncology 137 (2015) 591599598

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