Management of giant ovarian tumors in elderly adults: Preoperative evaluation using comprehensive geriatric assessment and estimation of physiologic ability and surgical stress and perioperative management effectiveness using Aron Alpha method and enhanced recovery after surgery

Abstract Purpose: We assessed the effectiveness of preoperative evaluation using comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS), the Aron Alpha method, and perioperative management based on Enhanced Recovery After Surgery (ERAS) for giant ovarian tumors in elderly adults. Methods: We focused on five giant ovarian tumor cases among elderly patients. Preoperative evaluation using the E-PASS scoring system and CGA was performed. Furthermore, the minimally invasive surgical method, the Aron Alpha method, was conducted, and we performed perioperative management using ERAS. Results: The mean age was 75.8±8.8 years, and the comorbidities were hypertension in three cases, hyperlipidemia in two cases, angina pectoris in one case, cholecystitis in one case, and lower extremity varicose veins in one case. The mean tumor size was 21.0±5.4 cm. The examination using the E-PASS scoring system showed a preoperative risk score of 0.7±0.4, surgical stress score of 0, and comprehensive risk score of 0.3±0.3. In CGA, two cases had problems with instrumental activities of daily living and cognitive function. The mean duration of surgery was 89.0±16.6 minutes, and the mean blood loss was 56.0±65.4 mL. No surgery-associated complications were observed, and early postoperative ambulation, rehabilitation intervention, and postoperative analgesic management were conducted. No patients had prolonged hospitalization and activities of daily living decline. Conclusion: We were able to confirm the usefulness and safety of the minimally invasive Aron Alpha method and ERAS-based perioperative management of giant ovarian tumors in elderly patients by performing a detailed preoperative evaluation using CGA and E-PASS.