Bowel resection at the time of primary cytoreduction for epithelial ovarian cancer

BACKGROUND: The purpose of this study was to determine the morbidity and su rvival associated with bowel resection at the time of primary cytoreductive surgery for ovarian cancer. STUDY DESIGN: We reviewed all patients undergoing bowel resection by gyneco logic oncology faculty at the time of primary cytoreduction for advanced ep ithelial ovarian cancer diagnosed between 1983 and 1995. RESULTS: There were 105 patients meeting the above criteria. The median age was 65 years (range 34 to 85 years). There were 76 stage III and 25 stage IV cancers. The primary indication for bowel resection was tumor debulking in 92% of the patients. Seventy patients had segmental resection of the col on only, and 22 patients underwent resections that inducted the large and s mall bowels. Mean operating time was 260 minutes and mean estimated blood l oss was 1,447 mL. Thirty-three (31%) patients were optimally cytoreduced to less than 1 cm residual disease. Ten patients experienced major complicati ons directly related to bowel resection, including bowel fistula (4 patient s), early postoperative bowel obstruction (5 patients), and stomal hernia ( 1 patient). Other morbidity included ileus for more than 10 days (18 patien ts), cardiac complications (17 patients), pneumonia (8 patients), sepsis (5 patients), and thromboembolism (4 patients). Six patients died and five pa tients required reexploration within 30 days of operation. Patients with pr eoperative bowel obstruction and suboptimal residual disease were more like ly to have postoperative morbidity. Median survival in the optimally debulk ed patients was 35 months compared with 18 months in patients suboptimally cytoreduced (p = 0.006). Multivariate analysis demonstrated that optimal de bulking (p = 0.009) and platinum chemotherapy (p = 0.00006) were independen tly associated with improved survival. Age, International Federation of Gyn ecologia Oncologists stage, American Society of Anesthesiologists class, an d paclitaxel chemotherapy did not influence survival. CONCLUSIONS: In patients undergoing bowel resection at the time of primary cytoreduction for ovarian cancer, optimal cytoreduction to less than I cm r esidual disease results in improved survival. Morbidity is common but is co mparable to other published series of ovarian cancer patients undergoing pr imary cytoreductive surgery without bowel resection. Additionally, patients with preoperative bowel obstruction and suboptimal residual disease are mo re likely to have serious morbidity. (J Am Coll Surg 2001; 193:626-632. (C) 2001 by the American College of Surgeons).