En-bloc pelvic resection with concomitant rectosigmoid colectomy and immediate anastomosis as part of primary cytoreductive surgery for patients with advanced ovarian cancer

Eur J Gynaecol Oncol. 2014;35(4):400-7.

Abstract

Objective: To assess the authors' experiences in en bloc pelvic resection with concomitant rectosigmoid colectomy and primary anastomosis as a part of primary cytoreductive surgery for patients with advanced ovarian cancer.

Materials and methods: Atotal of 22 patients with FIGO Stage IIB-IV epithelial ovarian cancer who underwent en bloc pelvic resection with anastomosis were retrospectively reviewed. Data analyses were carried out using SPSS 10.0 and descriptive statistics, Kaplan-Meier survival curves, and Log Rank (Mantel-Cox) test were used for statistical estimations.

Results: Median age was 58.8 years. FIGO stage distribution of the patients was; one (4.5%) IIB, three (13.7%) IIC, three (13.7%) IIIA, six (27.3%) IIIB, and nine (40.9%) IIIC. Median peritoneal cancer index (PCI) was 8 (range 5-22) and optimal cytoreduction was achieved in 18 patients (81.8%) of whom 13 (59.1%) had no macroscopic residual disease (complete cytoreduction). There was no perioperative mortality. A total of nine complications occurred in seven (31.8%) patients. Anastomotic leakage was observed in one (4.5%) patient. There was no re-laparotomy. Mean follow-up time was 60 months. There were 15 (68.2%) recurrences of which 12 (80%) presented in extra-pelvic localizations. Mean disease-free survival (DFS) and overall survival (OVS) were estimated as 43.6 and 50.5 months, respectively. Patients with complete cytoreduction had a better DFS (p = 0.006) and OVS (p = 0.003) than those with incomplete cytoreduction.

Conclusion: En bloc pelvic resection, as a part of surgical cytoreduction, seems to be a safe and effective procedure in many patients with advanced ovarian cancer if required. Despite relatively high general complication rate, anastomosis-related morbidity of this procedure is low as 0.8%. Nevertheless, surgical plan and perioperative care should be personalized according to medical and surgical conditions of the patient.

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adenocarcinoma, Clear Cell / pathology
  • Adenocarcinoma, Clear Cell / surgery
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / surgery
  • Adult
  • Aged
  • Anastomosis, Surgical
  • Carcinoma, Endometrioid / pathology
  • Carcinoma, Endometrioid / surgery
  • Carcinoma, Ovarian Epithelial
  • Cohort Studies
  • Colectomy / methods
  • Colon, Sigmoid / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Hysterectomy / methods
  • Kaplan-Meier Estimate
  • Lymph Node Excision
  • Middle Aged
  • Neoplasms, Glandular and Epithelial / pathology
  • Neoplasms, Glandular and Epithelial / surgery*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery*
  • Ovariectomy / methods
  • Pelvic Exenteration / methods*
  • Peritoneum / surgery*
  • Proctocolectomy, Restorative / methods
  • Rectum / surgery*
  • Retrospective Studies
  • Treatment Outcome