The feasibility and morbidity of distal pancreatectomy in extensive cytoreductive surgery for advanced epithelial ovarian cancer.

Abstract

Pancreatic metastasis of ovarian cancer is extremely rare and its therapeutic approach is not well documented. The objective of this study is to evaluate the feasibility and morbidity of pancreatic resection as a component of extensive cytoreductive surgery in epithelial ovarian cancer (EOC) patients with pancreas metastasis. Between December 2000 and February 2003, 98 EOC patients were treated with primary cytoreduction. Six (6.12%) of these patients had pancreatic tail metastasis and were operated on using the distal pancreatectomy. Preoperatively, only 1 (16.7%) of the 6 patients had signs of metastasis to the pancreas on computed tomography (CT). Optimal cytoreduction (absent or < or =1 cm macroscopic residual tumor size) was achieved in all patients. In the early postoperative period, there were 4 patients (66.7%) with complications and no perioperative mortality. In 1 patient (16.7%), glucose intolerance as a late complication of pancreatic resection was detected. All patients received six cycles of platinum-based adjuvant chemotherapy following a cytoreductive operation. Mean follow-up was 27 months (range 9-36), and 3 (50%) patients are still alive at the end of the study period. The two-year survival rate was 66.7%. In conclusion, if optimal cytoreduction is foreseen in advanced epithelial ovarian cancer with pancreatic tail metastasis, distal pancreatectomy should be kept in mind. This procedure has acceptable morbidity and seems to be an attribute for survival.