Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer☆
Introduction
Optimal cytoreduction is one of the most powerful predictors of disease-free and overall survival in women with advanced-stage epithelial ovarian cancer [1]. Extensive metastatic disease to the neighboring pelvic viscera often results in the need for rectosigmoid resection to achieve optimal cytoreduction. The technique of en bloc resection of pelvic tumor, adjacent rectosigmoid, and pelvic peritoneum with primary anastomosis has been described, with acceptable associated morbidity [2], [3], [4], [5].
Disruption of the anastomosis leading to clinical anastomotic leak is one of the most feared complications after colonic resection. Anastomotic leak is associated with considerable morbidity, including impaired long-term functional outcome [6], and increased mortality [7], [8], [9]. Several studies from the colorectal literature have found that prolonged operating time and blood-product transfusion were important factors associated with anastomotic leak [10], [11]. However, others have suggested that ileostomies should be reserved for those with low anastomoses [10], [12].
We have previously reported that with the incorporation of extensive upper abdominal surgical procedures, optimal cytoreduction rates can be significantly increased [13]. However, the increase in optimal cytoreduction rates was also associated with a significant increase in operating time, intraoperative estimated blood loss (EBL), and the use of blood-product transfusion. Therefore, the objective of this study was to assess the morbidity and mortality associated with low anterior resection (LAR) and primary anastomosis performed for primary cytoreduction in a patient population with extended operating times and significant EBL.
Section snippets
Methods
Our prospectively collected Gynecology Service Database was used to identify all patients with stages IIIC and IV epithelial ovarian cancer who underwent an LAR and primary anastomosis as part of primary cytoreductive surgery between January 1994 and June 2004. Exclusion criteria included the use of neoadjuvant chemotherapy, primary cytoreduction at another institution, the use of an end colostomy at the time of LAR, tumors of low malignant potential, and LAR performed for recurrent disease.
The
Results
Seventy patients that met our inclusion criteria were identified; these patients formed our study cohort. The median age was 59 years (range, 25–82) and the majority of the patients had stage IIIC disease with poorly differentiated tumors of papillary serous histology. Patient and tumor characteristics are presented in Table 2.
Sixty-eight (97%) of the 70 patients underwent preoperative bowel preparation. One of the patients who did not undergo a bowel preparation had a large bowel obstruction;
Discussion
The rectosigmoid is a frequent site of involvement by epithelial ovarian cancer, usually occurring by direct tumor extension and often resulting in obliteration of the cul-de-sac. Gynecologic oncologists frequently perform resection of the rectosigmoid with primary anastomosis as part of an en bloc tumor resection in patients with epithelial ovarian cancer. This results in high rates of optimal cytoreduction with acceptable morbidity [2], [3], [4], [5]. Our series shows LAR to be an effective
Acknowledgments
This work was funded by the Albritton Foundation and the Roy M. Speer Foundation.
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A comparison of end-to-end and end-to-side anastomosis following rectosigmoid resection in ovarian cancer cytoreductive surgery
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Survival impact of bowel resection at the time of interval cytoreductive surgery for advanced ovarian cancer
2021, Gynecologic Oncology ReportsCitation Excerpt :These findings suggest that post-operative complications related to bowel resection and their sequelae, and not disease recurrence and progression, may contribute to the observed increased risk of death among the bowel resection group. Our findings are comparable to previously published studies about mortality (Kalogera et al., 2013; Grimm et al., 2017) and peri-operative morbidity (Tozzi et al., 2018; Richardson et al., 2006; Fournier et al., 2018; Mourton et al., 2005) after bowel resection during primary cytoreductive surgery. Our findings contribute to the small body of literature on the impact of bowel resection at the time of interval cytoreduction.
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Presented at the Thirty-Sixth Annual Meeting of the Society of Gynecologic Oncologists, Miami Beach, FL, USA; March 19–23, 2005.