Abstract
BackgroundMore information is needed on the anatomopathological outcome variables indicating the appropriate surgical strategy for the colorectal resections often needed during cytoreduction for ovarian cancer.MethodsFrom a phase-II study cohort including 70 patients with primary advanced or recurrent ovarian cancer with diffuse peritoneal metastases treated from November 2000 to April 2009, we selected for this study the 52 consecutive patients who needed colorectal resection. Data collected included type of colorectal resection, peritoneal cancer index (PCI), histopathology (depth of bowel-wall invasion and lymph-node spread), cytoreduction rate and outcome. Correlations were tested between possible prognostic factors and Kaplan-Meier five-year overall and disease-free survival. A Cox multivariate regression model was used to identify independent variables associated with outcome.ResultsIn the 52 patients, the optimal cytoreduction rate was 86.5% (CC0/1). In all patients, implants infiltrated deeply into the bowel wall, in 75% of the cases up to the muscular and mucosal layer. Lymph-node metastases were detected in 50% of the cases; mesenteric nodes were involved in 42.3%. Most patients (52%) had an uneventful postoperative course. Operative mortality was 3.8%. The five-year survival rate was 49.9% and five-year disease-free survival was 36.7%. Cox regression analysis identified as the main prognostic factors completeness of cytoreduction and depth of bowel wall invasion.ConclusionsOur findings suggest that the major independent prognostic factors in patients with advanced ovarian cancer needing colorectal resections are completeness of cytoreduction and depth of bowel wall invasion. Surgical management and pathological assessment should be aware of and deal with dual locoregional and mesenteric lymphatic spread.
Highlights
More information is needed on the anatomopathological outcome variables indicating the appropriate surgical strategy for the colorectal resections often needed during cytoreduction for ovarian cancer
From a phase II trial including a cohort of 70 patients with primary advanced or recurrent ovarian cancer with diffuse peritoneal metastases treated with peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) from November 2000 to April 2009, we selected for study the 52 consecutive patients who had ovarian implants invading at least a single colorectal segment confirmed by intraoperative assessment and requiring colorectal resection
In the 52 patients selected for study because malignant disease required colorectal resections, peritonectomy procedures during cytoreduction comprised a mean number of 7.5 resections per patient (Table 2)
Summary
More information is needed on the anatomopathological outcome variables indicating the appropriate surgical strategy for the colorectal resections often needed during cytoreduction for ovarian cancer. Aggressive surgical cytoreduction and platinum- plus taxane-based chemotherapy have in recent years improved median overall survival in advanced ovarian cancer [3,4], relapse rates reach 80% and long-term cure rates languish between 20 and 30% [4,5,6]. Some compared the long-term results in patients who needed a colorectal resection (for example a rectosigmoid resection) and those in whom it could be avoided by removing the peritoneum in the Douglas pouch. Surprisingly, they found that the results in the two groups overlapped [20] because outcomes in patients with advanced ovarian cancer depend crucially on the completeness of cytoreduction achieved, regardless of the surgical procedures used. No studies have yet clearly identified prognostic factors linking colorectal resection required during cytoreduction in these patients with survival
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