Results of optimal debulking surgery with bowel resection in patients with advanced ovarian cancer

Abstract

BackgroundThe surgical treatment of patients with advanced-stage ovarian cancer is based on maximal cytoreduction with widening the debulking on the extra-ovarian tissues and infiltrated organs. The purpose of the study was to assess the outcome after optimal cytoreduction with partial bowel resection and to find the risk factors of relapse. Another goal was the quantitative and qualitative assessment of intra- and postoperative complications in the studied group.MethodsThe analysis of debulking procedures with intestinal resection and postoperative period in 33 ovarian cancer patients, The International Federation of Gynecology and Obstetrics (FIGO) stages III and IV, was performed.ResultsThe optimal cytoreduction defined as less than 1.0 cm residual disease was achieved in all patients including the following: 26 patients (78.8 %) with no macroscopic residual disease, 4 patients (12.1 %) with the largest residual tumor less than 0.5, and 3 patients (9.1 %) with 0.5 cm to less than 1.0 cm residual disease. The rectosigmoid resection was the most common surgical procedure (n = 27). The risk of relapse was significantly higher in subjects who had the macroscopic residual tumor left during the primary operation (57.1 vs. 11.5 %, P = 0.035). A primary bowel tumor size was another predictor of relapse. The maximum tumor diameter was significantly larger (14.9 ± 6.7 cm vs. 10.3 ± 4.7 cm, P = 0.047) in patients who developed the relapse.ConclusionsAs presented in the article, our outcomes and other authors’ observations indicate that debulking surgery with bowel resection in patients with advanced ovarian cancer brings good results. Complications connected with bowel surgery are to be accepted. The interesting thing is that a primary bowel tumor size was a predictor of relapse.

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

“…Another study reported that 87% of patients undergoing primary debulking surgery were indicated for bowel surgery . To date, many studies have reported that surgical resection of the involved bowel is feasible with an acceptable complication rate and is related to a survival benefit . However, there are few reports about the extent or number of resections in bowel surgeries.…”

“…As ovarian cancer often presents in the advanced stage and frequently involves the small and large bowels, bowel surgery has been a crucial part of debulking procedures . Several studies have reported that surgical resection of the involved bowel is feasible with an acceptable complication rate and is related to a survival benefit . To achieve optimal debulking, extensive bowel resection including multiple bowel resection or subtotal colectomy is sometimes warranted.…”

“…8,9 Several studies have reported that surgical resection of the involved bowel is feasible with an acceptable complication rate and is related to a survival benefit. [10][11][12][13][14][15] To achieve optimal debulking, extensive bowel resection including multiple bowel resection or subtotal colectomy is sometimes warranted. However, thus far, few studies have focused on the extent or number of resections of bowel surgeries and their feasibility or perioperative outcomes.…”

Rectosigmoidian Involvement in Advanced-stage Ovarian Cancer – Intraoperative Decisions

“…Whenever the surgical team decides to perform a low rectosigmoidian resection with anastomosis, the surgeon should take into consideration the fact that in this context the risk of anastomotic dehiscence remains one of the most frequent and serious complications, ranging between 0.8 and 6.8% (21,22). In the meantime, the factors contributing to a higher risk of anastomotic leaks consist of a higher length of operative time, a higher need of blood transfusion and a shorter length of the distal anastomotic partner (2). Whenever one of these situations are encountered, performing a diverting ileostomy or even a Hartmann procedure might be performed in order to minimize the risk of a life-threatening complication such as an anastomotic leak.…”

“…Background Ovarian cancer is a common malignancy encountered in women worldwide, presenting an increasing incidence in the last decades. Among European women it is estimated that the incidence of ovarian cancer reached 4% of all malignancies, being in the meantime the sixth cause of cancer related death (1,2). This fact is mainly related to the high capacity of spread of the malignant process via multiple pathways, leading to the apparition of disseminated lesions at the time of diagnosis.…”