Extensive Primary Cytoreductive Surgery for Advanced Epithelial Ovarian Cancer

Abstract

This retrospective descriptive study provides our experience with a subset of 30 patients with Stage III or Stage IV ovarian cancer who presented at initial laparotomy with advanced disease in whom large (greater than 10 cm) confluent nodules, plaques, or nodal metastatic deposits were found intraperitoneally. The nature of the extirpative procedures performed resuited in extensive primary cytoreductive surgery involving multiple organ resection. All the patients had removal of their primary tumor from the pelvis, an omentectomy, and appendectomy. In addition to resection of rectosigmoid colon in 27 patients, 11 had concomitant resection of the small bowel and 13 of the large bowel, 3 of which were hemicolectomy. In the remaining 3 patients who did not have rectosigmoid resection a hemicolectomy was performed, 2 of which also had resection of small bowel. Three patients required a primary colostomy, while 1 had a colostomy as a secondary procedure following the development of a rectovaginal fistula. Eight patients had a splenectomy, 2 had resection of portion of the tail of the pancreas, 10 had a partial urinary bladder cystectomy and 2 had a nephrectomy. The average operating time and blood loss was 5 hr 18 min and 2900 ml, respectively. Two patients died within 48 hr postoperatively, two required a second laparotomy for persistent intraabdominal bleeding, and six developed late thrombotic complications. In total 43% of the patients developed serious postoperative complications. We present our findings and allude to the morbidity and mortality that may ensue when such extensive cytoreductive surgery is undertaken.