Gastrointestinal surgery in patients with ovarian cancer

Objectives. The objectives were to assess indications for and outcome and m orbidity of gastrointestinal surgery in patients with ovarian cancer. Methods. We reviewed 364 patients with ovarian cancer who underwent a total of 491 operations including a gastrointestinal procedure over a 10-year pe riod. The 491 operations comprised 180 primary surgical procedures (37%), 4 4 second-look laparotomies (9%), and 267 procedures for recurrence or palli ation (54%). Results. Debulking of disease was the indication for bowel surgery for 87, 45, and 62% of cases in the three groups, respectively. Bowel obstruction w as an indication in 14% of patients at primary surgery and in 34% at second ary surgery (P < 0.05). Rectosigmoid resection was the most common bowel op eration overall, particularly in the primary surgery group (65%). Colostomy was performed in 30% of the cases of rectosigmoid resection at primary sur gery. Small-bowel resection was most common in the surgery for recurrence o r palliation group. The blood transfusion rate was 79%. Febrile morbidity w as the most common complication overall (29%), with no significant differen ces among groups. Four patients (0.8%) required reoperation for an abscess or anastomotic leak. Nineteen operations (3.9%) were followed by death with in 30 days, with no significant differences among groups. A weighted Cox mo del estimated that 21, 42, and 11% of patients would be alive 5 years after primary surgery, second-look laparotomy, and surgery for recurrence or pal liation, respectively (P = 0.01). Conclusion. Gastrointestinal surgery is frequently indicated during operati ons for ovarian cancer. Gynecologic cancer surgeons should be trained accor dingly. Patients with possibly malignant ovarian masses should receive preo perative bowel preparation and be counseled that bowel surgery may be neede d but colostomy is not frequently required, (C) 2001 Academic Press.