Bowel resection at the time of primary cytoreduction improves disease-free survival in epithelial ovarian cancer patients and is associated with acceptable morbidity

Abstract

Abstract Introduction: To determine the morbidity, disease-free (DFS) and overall survival (OS) associated with bowel resection at the time of primary cytoreductive surgery for advanced epithelial ovarian cancer (EOC) in the era of platinum/taxane chemotherapy. Methods: A computerized database identified 37 women who underwent a bowel resection at the time of primary cytoreduction for advanced EOC and subsequently received platinum/taxane chemotherapy from 1996 to 2000. Data was collected on demographics, stage, histology, debulking status, surgical morbidity, recurrence, and survival. Survival analysis and comparisons were performed using the Kaplan Meier method and log-rank test. Results: Of 37 patients with Stage III/IV EOC, 20 patients (54%) were optimally debulked to less than 1 cm residual disease. Four-year OS was 78% in the optimally debulked group versus 53% in the suboptimally debulked group (p = 0.20). Four-year DFS in the optimally debulked group was 46% versus 0% in the suboptimally debulked group (p = 0.004). The primary indication for bowel resection was tumor debulking in 86% of patients. Five patients (14%) experienced a major postoperative complication including stroke, small bowel obstruction, colon obstruction, entercutaneous fistula, and pelvic abscess. Other perioperative morbidity included pneumonia (3 patients), ileus (6 patients), and wound infection and/or seroma (3 patients). Mean estimated blood loss was 700 ml; mean hospital stay was 7 days (range 3–15). Conclusions: Patients with advanced EOC who undergo bowel resection and are optimally debulked have a significant improvement in DFS. Bowel resection at the time of primary cytoreductive surgery has acceptable perioperative morbidity.