Division of pedicles by stapling during cytoreductive surgery for ovarian cancer

Abstract

Objective. To determine the potential of dividing vascular pedicles by stapling to reduce operative time, blood loss, and morbidity associated with cytoreductive operations for advanced ovarian cancer. Methods. A case-control study was undertaken to compare operative outcomes for patients undergoing primary cytoreductive operations for ovarian cancer using two different operative strategies. Between 2002 and 2004, both stapling and conventional techniques were used to divide vascular pedicles for 50 consecutive patients requiring modified posterior exenterations (en-bloc resection of internal reproductive organs, pelvic peritoneum, and recto-sigmoid colon) and upper abdominal procedures in the context of primary cytoreduction for stage IIIC and IV ovarian cancer. The operative time, blood loss, transfusion rate, hospitalization, and incidence of complications were compared to outcomes of 50 consecutive patients operated on between 1994 and 1997 for whom stapling was not used to divide pedicles (chi-square test for binomial data, and t-test analysis for continuous data). Results. Both groups were equivalent with respect to disease severity, extent of upper abdominal surgery, and cytoreductive outcomes. The group for whom stapling devises were used to divide pedicles had a significantly reduced total operative time 179 min vs. 284 min, P < 0.001), estimated blood loss (1170 ml vs. 1782 ml, P = 0.004), and transfusion rate (3.6 units packed red cells vs. 5.0 units packed red blood cells, P = 0.03). Conclusion. Stapling of vascular pedicles significantly reduces the operative time and blood loss for patients undergoing extensive primary cytoreductive operations for advanced ovarian cancer.