The Role of Bowel Resection in the Primary Debulking of Ovarian and Peritoneal Cancer

Abstract

In Brief Objectives: Extensive debulking is recommended for the primary operative management of advanced ovarian and peritoneal cancer. Patients with advanced ovarian and peritoneal cancer frequently develop intestinal obstruction and intestinal resection with anastomosis or colostomy often offers the only chance to restore gastrointestinal function and provide complete cytoreduction. The purpose of this study was to compare our results with outcomes of other institutions. Methods: The study was a retrospective review of 29 women who underwent bowel resection as a part of primary surgical debulking for advanced ovarian or peritoneal cancer from 1995 to 2003. Results: Twenty-seven patients had ovarian cancer and 2 patients had peritoneal cancer. The ages ranged from 49 to 93 years. According to the International Federation of Gynecology and Obstetrics (FIGO) staging system, 2 patients were in FIGO stage II, 16 patients were in FIGO stage III, and 11 patients were in FIGO stage IV. Twenty-six patients had optimal debulking with no gross residual tumor. The intestinal procedures performed included 14 sigmoid resections with colostomy, 9 sigmoid resections with reanastomosis, 4 transverse colon resections with reanastomosis, 1 right hemicolectomy with ileo-transverse colon reanastomosis, 1 total colectomy, 2 ileostomies, 5 partial small bowel resections with reanastomosis, and 1 gastrostomy. Eight patients had more than one intestinal procedure. There was one postoperative death on the fifth postoperative day due to respiratory failure. Postoperative complications included 1 anastomotic leak with peritonitis, 1 pelvic abscess, 1 intraluminal colonic anastomotic bleed, 3 wound infections, 2 urinary tract infections, and one case of pneumonia. One patient developed disseminated intravascular coagulopathy intraoperatively. The median operating time was 3 hours and 55 minutes (range 2 hours 23 minutes-6 hours 5 minutes). The mean blood loss was 1256 mL (range 200–7500). The hospital stay ranged from 6 to 36 days (mean 15). Despite aggressive postoperative chemotherapy, only 1 stage II patient and 4 stage III patients have survived (17.2%). The median survival for the whole group was 21 months (mean 25, range 1 to 78). Conclusions: Intestinal resection to relieve obstruction or optimally debulk patients with advanced ovarian or peritoneal cancer can prolong survival and be curative in some patients and palliative in others. Bowel resection at the time of primary cytoreductive surgery in patients with advanced ovarian or peritoneal cancer is associated with acceptable perioperative morbidity.