Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma

BACKGROUND. The impact of radical bowel resection with multiple organ resec tion on the survival if patients with advanced ovarian carcinoma has not be en well defined. The authors investigated whether primary cytoreductive sur gery including rectosigmoid colon resection would affect the recurrence fre e interval and survival of these patients. METHODS. Between April 1990 and April 1997, 66 previously untreated Stage I IIC-IV ovarian carcinoma patients with macroscopic involvement of the recto sigmoid colon were enrolled. All patients underwent cytoreductive surgery w ith rectosigmoid colon resection to remove residual tumor less than 2 cm in greatest dimension and received 6 cycles of cisplatin-based postoperative chemotherapy RESULTS. The median follow-up was 26 months (range, 7-104 months). In multi variate analysis, residual disease and depth of tumor infiltration of the b owel wall were independently associated with overall survival and recurrenc e free interval. Disease stage was independently associated only with overa ll survival. Residual tumor was the most strongly predictive factor for rec urrence or death. The 2-year estimated survival rates according to the amou nt of residual tumor were 100% for 24 patients with no macroscopic residual disease and 77.3% for 28 patients with residual disease less than 1 cm. No ne of the 14 patients with residual disease larger than 1 cm were alive 2-y ears after operation. Overall, 48 patients (72.7%) developed disease recurr ence: 43 (65.1%) in the abdomen, 19 (29.8%) in the liver, and 3 (4.5%) in t he pelvis. CONCLUSIONS. The current findings suggest that cytoreductive surgery with r ectosigmoid colon resection should be considered for ovarian carcinoma pati ents with bulky pelvic disease to help ensure that they are left with no re sidual disease after debulking surgery. (C) 2000 American Cancer Society.