The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery

Grimm, Christoph; Harter, Philipp; Alesina, Pier Francesco; Prader, Sonia; Schneider, Stephanie; Ataseven, Beyhan; Meier, Beate; Brunkhorst, Violetta; Hinrichs, Jakob; Kurzeder, Christian; Heitz, Florian; Kahl, Annett; Traut, Alexander; Groeben, Harald; Walz, Martin K.; Bois, Andreas du

doi:10.1016/j.ygyno.2017.06.007

Cited by 75 publications

(78 citation statements)

References 23 publications

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“…Only the study of Grimm et al 11 comprised a large cohort of patients undergoing multiple bowel resections. Grimm et al 11 reported an AL rate of 9.0% in patients with rectosigmoid resection and an additional bowel resection, comparable to a 6.3% rate in the present study. 11 In the previous study, AL rates in patients with combined rectosigmoid and large bowel resection (8.9%) were comparable to AL rates in patients undergoing a combined rectosigmoid and small bowel resection (9.1%).…”

Section: Discussionsupporting

confidence: 87%

“…Grimm et al 11 reported an AL rate of 9.0% in patients with rectosigmoid resection and an additional bowel resection, comparable to a 6.3% rate in the present study. 11 In the previous study, AL rates in patients with combined rectosigmoid and large bowel resection (8.9%) were comparable to AL rates in patients undergoing a combined rectosigmoid and small bowel resection (9.1%). This is in contrast to data of the current study, in which AL was observed only in the cohort of patients with rectosigmoid resection and large bowel resection (8.3%).…”

Section: Discussionsupporting

confidence: 87%

“…Bacalbasa et al 9 reported a 2% AL rate; Peiretti et al, 7 3%; Yildirim et al, 13 4.5%; and Grimm et al, 11 6.9% AL rate. Of note, the majority of these studies excluded or comprised only a few patients with multiple bowel resections during primary surgery for advanced EOC.…”

Section: Discussionmentioning

confidence: 96%

“…This is in line with previous studies. 11,14 With respect to the prognostic implication of AL, it has to be kept in mind that the number of events, that is, patients with AL (n = 9), was limited in the present study. Anastomotic leakage was associated with shortened PFS and OS in univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Both reported AL to have a negative impact on OS rates. Whereas Grimm et al 11 Therefore, the present study is set out to assess AL rates and risk factors for AL to evaluate the safety and efficacy of primary cytoreductive surgery in advanced EOC undergoing 1 or more bowel resections including the rectosigmoid. In addition, impact of AL on OS was evaluated.…”

mentioning

confidence: 99%

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Predictive and Prognostic Implication of Bowel Resections During Primary Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer

Bartl

Schwameis

Stift

et al. 2018

Int J Gynecol Cancer

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ObjectivesThe aims of this study were to assess anastomotic leakage (AL) rate and risk factors for AL in patients with advanced epithelial ovarian cancer (EOC) undergoing cytoreductive surgery including bowel resections and to evaluate the prognostic implication of AL.MethodsData of 350 consecutive patients with International Federation of Gynecology and Obstetrics EOC stage IIB–IV who underwent cytoreductive surgery at the Department of General Gynecology and Gynecologic Oncology of the General Hospital of Vienna between 2003 and 2017 were collected. Within this cohort, 192 patients (54.9%) underwent at least 1 bowel resection and were further analyzed. Preoperative risk factors for AL were computed using logistic regression models. Prognostic factors for overall survival were evaluated by using log-rank tests and multivariable Cox regression model.ResultsOverall, the AL rate was 4.7% for patients with advanced EOC undergoing cytoreductive surgery with at least 1 bowel resection, including patients with multiple large bowel resections. The AL rate for patients with isolated rectosigmoid resection was 1.9%. In univariate analysis, the number of anastomoses per surgery (P = 0.04) was associated with the occurrence of AL. In multivariable analysis, rectosigmoid resection with additional large bowel resection was associated with a higher risk of AL compared with isolated rectosigmoid resection (P = 0.046; odds ratio, 7.23 [95% confidence interval, 1.04–50.39]). Anastomotic leakage was associated with decreased overall survival (P = 0.04) in univariate but not in multivariable survival analysis.ConclusionsAnastomotic leakage rate after rectosigmoid resection in advanced EOC is acceptably low and outweighs increased perioperative risks when performed in a high-volume institution. Nonetheless, the occurrence of AL is a severe adverse event, which even seems to negatively affect patients’ overall prognosis. As no factor could be identified to clearly predict AL, extensive procedures comprising multiple bowel resections, should be avoided particularly when complete resection cannot be achieved.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictive and Prognostic Implication of Bowel Resections During Primary Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer

Bartl

Schwameis

Stift

et al. 2018

Int J Gynecol Cancer

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Bowel Resection Outcomes in Ovarian Cancer Cytoreductive Surgery by Surgeon Specialty

Ebott,

Has,

Raker

et al. 2024

JAMA Surg

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ImportanceExtensive bowel surgery is often necessary to achieve complete cytoreduction in patients with epithelial ovarian cancer. Regardless of who performs the surgery, it has been well documented that bowel resections are a high-risk procedure and an anastomotic leak is a severe complication that can occur. There are few studies addressing whether surgeon type impacts surgical outcomes in this patient population.ObjectiveTo compare surgical outcomes between gynecologic oncologist, general surgeons, and a 2-surgeon team approach for patients with advanced epithelial ovarian cancer who underwent bowel surgery during cytoreductive debulking.Design, Setting, ParticipantsThis retrospective cohort study used the American College of Surgeons’ National Surgical Quality Improvement Program datasets from 2012 through 2020. The aforementioned years of the dataset were analyzed from March 2022 to March 2023 and reanalyzed in May 2024 for quality assurance. Analysis of cytoreductive surgeries performed by a gynecologic oncologist, a general surgeon, or a 2-surgeon team approach for patients with ovarian cancer recorded in National Surgical Quality Improvement Program datasets was included. The 2-surgeon team approach included any combination of the aforementioned surgical specialties.Main outcome and measureThe primary outcome of interest was anastomotic leak after bowel surgery during ovarian cancer debulking.ResultsA total of 1810 patients were included in the study; in the general surgery cohort, mean (SD) patient age was 65.1 (11.1) years and mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was 26.9 (7.4); in the gynecologic oncology cohort, mean (SD) patient age was 63.5 (11.7) years and mean BMI (SD) was 27.7 (6.5); and in the 2-surgeon team cohort, mean (SD) patient age 62.4 (12.1) years and mean (SD) BMI was 28.1 (7.0). Gynecologic oncologists performed 1217 cases (67.2%), general surgery performed 97 cases (5.4%), and 496 cases had 2-surgeon teams involved (27.4%). Bivariate analysis revealed an anastomotic leak rate of 3.6% for gynecologic oncologists, 5.2% for general surgeons, and 0.4% for cases that had 2 surgical teams involved (P &lt; .001). By multivariable analysis, the adjusted odds ratio for anastomotic leak was 1.53 (95% CI, 0.59-3.96) for the general surgeon group (P = .38) vs an adjusted odds ratio of 0.11 (95% CI, 0.03-0.47) for the 2-surgeon team approach (P = .003) with the referent being gynecologic oncology.Conclusion and RelevanceIn this study, the anastomotic leak rate was found to be lower when 2 surgeons participated in the case, regardless of the surgical specialty. These results suggest that team-based care improves surgical outcomes.

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Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer

Hiu

Bryant

Gajjar

et al. 2022

Cochrane Database of Systematic Reviews

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Background-Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment.Objectives-To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer.Search methods-We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.Selection criteria-Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult women with advanced primary epithelial ovarian cancer.Data collection and analysis-Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed.

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The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery

Cited by 75 publications

References 23 publications

Predictive and Prognostic Implication of Bowel Resections During Primary Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer

Predictive and Prognostic Implication of Bowel Resections During Primary Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer

Bowel Resection Outcomes in Ovarian Cancer Cytoreductive Surgery by Surgeon Specialty

Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer

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