Perioperative outcomes of extensive bowel resection during cytoreductive surgery in patients with advanced ovarian cancer

Abstract

Background and Objectives To achieve optimal cytoreduction, extensive bowel resections are sometimes required in patients with advanced ovarian cancer. Few studies have focused on the extent or number of resections of bowel surgeries and their feasibility. Methods We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent bowel surgery as part of debulking procedures at Ajou University Hospital from 2006 to 2018. Patients who received extensive bowel resections (two‐segment resections or subtotal colectomy) were identified, and their perioperative outcomes were evaluated. Results A total of 172 patients underwent bowel surgery. Of them, 128 (74.4%) underwent one‐segment bowel resection, 25 (14.5%) underwent two‐segment bowel resections, and 19 (11.1%) underwent subtotal colectomy. Although the operative time, transfusion rate, and postoperative bleeding events were higher in patients who underwent extensive bowel resection, the rates of perioperative complications were not significantly higher in this group. Anastomotic leakage occurred in two (1.5%) patients in the one‐segment resection group, one (4.2%) patient in the multiple resection group, and two (10.5%) patients in the subtotal colectomy group. Conclusions Multiple bowel resections (up to two segments) are feasible and can be safely performed with an acceptable complication rate in patients with advanced ovarian cancer.

Well-trained gynecologic oncologists can perform bowel resection and upper abdominal surgery safely

“…However, the rate of anastomotic leakage was not significantly different between the 2 periods, and the rate of protective ileostomy was lower during the post-learning period than during the initial learning period because the intraoperative blood loss in post-learning period was less than in initial period. We showed that rectosigmoid resection with anastomosis for advanced ovarian cancer can be performed safely even without routine performance of protective ileostomy and that multiple bowel resections did not increase the risk of anastomotic leakage, which is compatible with previously reported studies describing this subject [3738].…”

The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients.

“…Ovarian cancer often spreads along the peritoneal surface and invades the bowel serosa and mesentery (9). According to a previous study, 72% of the advanced ovarian cancer patients had visible tumor in the small and large bowels (13).…”

“…The bowel resection rate during cytoreductive surgery ranged from 40-80% in institutions adopting radical surgery (12,(14)(15)(16). Two recent publications evaluated multiple bowel resections in ovarian cancer, one from Germany (12) and one from Korea (9). Given the small number of patients with anastomotic leak, we did not assess the underlying risk factors.…”

“…The bowel resections were dichotomized into one-segment and extensive bowel resection (at least two-segment) (9). The postoperative complications were graded according to Clavien-Dindo classification (CDC) (10) and further categorized into mild (CDC 0-2) and severe (CDC 3-5) subgroup (11).…”

Standard primary cytoreduction surgery (CRS) procedure for ovarian cancer (FIGO Stage IIB-IV)

“…Subgastric omentectomy is performed by dissecting the gastro colic ligament below the stomach also the gastrosplenic ligament is excised on the left (Figure 18a) (care is taken to avoid splenic laceration and bleeding while dealing with splenic ligament), as well as the omental bursa is exposed, examined the lesser omentum and the retroperitoneal organs of the upper abdomen 19,20 . In some cases, the resection of the lesser/greater omentum is performed to achieve tumor-free area (Figure 18b).…”