Surgical indications for combined partial rectosigmoidectomy in ovarian cancer.
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.
Takahashi
Osamu
O
Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita, Japan. takahashio@obgyn.med.akita-u.ac.jp
Sato
Naoki
N
Miura
Yoshinori
Y
Ogawa
Masaki
M
Fujimoto
Toshio
T
Tanaka
Hidenori
H
Sato
Hirokazu
H
Tanaka
Toshinobu
T
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