title: Surgical indications for combined partial rectosigmoidectomy in ovarian cancer.
abstract: OBJECTIVE
  To evaluate surgical indications for combined partial rectosigmoidectomy in ovarian cancer with direct invasion of the rectum and sigmoid colon or dissemination into the pouch of Douglas.
  
  
  METHODS
  Subjects comprised 25 patients with ovarian cancer who underwent primary surgery and rectosigmoidectomy between 1990 and 2002 at our hospital. Federation of Obstetrics and Gynecology staging of tumors was II (n = 6), III (n = 17) or IV (n = 2). The histologic type was serous adenocarcinoma (n = 18), clear cell adenocarcinoma (n = 4), and others (n = 3). Bowel resection was performed during primary surgery in 18 patients, and after neoadjuvant chemotherapy (NAC) in seven patients. Cumulative survival rate was compared between NAC and non-NAC groups. Patients were divided into three groups based on extent of surgical resection to compare survival rates: no residual tumor (n = 19); maximum residual tumor diameter <1 cm (n = 5); and maximum residual tumor diameter > or =1 cm (n = 1).
  
  
  RESULTS
  Cumulative 5-year survival was 41.3% for all patients. Cumulative 5-year survival in the 18 patients who underwent bowel resection during primary surgery was 62.2%, compared to 13.9% in the seven patients who underwent bowel resection after NAC. Cumulative 5-year survival based on extent of surgical resection was: no residual tumor, 60.8%; residual <1 cm, 0%; and residual > or =1 cm, 0%. Cumulative 5-year survival for patients with complete tumor resection (no residual tumor), excluding clear cell adenocarcinoma, was 79.5%.
  
  
  CONCLUSIONS
  In ovarian cancer with direct invasion of the rectum or sigmoid colon or dissemination into the pouch of Douglas, complete tumor resection with rectosigmoidectomy during primary surgery is associated with good clinical outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita, Japan. takahashio@obgyn.med.akita-u.ac.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Miura
authors.forename: Masaki
authors.initials: M
authors.lastname: Ogawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sato
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D012007:Rectum / Q000601:surgery