Can flexible sigmoidoscopy predict need for colorectal surgery in ovarian carcinoma?

Introduction: It is difficult to predict which patients with ovarian cancer will require bowel surgery. We propose that sigmoidoscopy performed by an experienced colorectal surgeon could predict the need for bowel resection a s part of optimum cytoreduction by assessment of rigidity and encasement of the rectosigmoid colon or mucusal involvement. Laparotomy may then be perf ormed electively in collaboration with a colorectal surgeon after administr ation of bowel preparation. Methods: In a prospective study 30 patients undergoing surgery for a high s uspicion of ovarian malignancy and with at least two of either a complex pe lvic mass on ultrasound, elevated CA125 or ascites were studied. Flexible s igmoidoscopy performed at time of admission was reported as "clear bowel", "external compression only" or "mucosal involvement" with the recommendatio n to "avoid resection" or "may need resection" Results: Sigmoidoscopy was completed in all patients and was well tolerated . Satisfactory preparation and evaluation was possible in 70% and did not d elay definitive surgery. 67% (20/30) of cases proved to have ovarian carcin oma. Overall prediction to avoid resection was correct in 21/25 and to rese ct in 5/9 with accurate prediction in those with ovarian cancer of 17/20 ca ses. This included 3/4 sigmoid colectomies for ovarian malignancy as part o f an optimum debulking procedure. Sigmoidoscopy was more accurate than rely ing on a history of change in bowel habit alone in predicting the need for bowel resection. Conclusions: Sigmoidoscopy was shown to be a practical procedure, causing n o significant morbidity in patients with ovarian carcinoma. Tn evaluating a pelvic mass it can exclude primary colorectal pathology and impending obst ruction. Flexible sigmoidoscopy correctly identified the majority of cases which required colorectal surgery and allowed an optimal resection to take place as a planned procedure.