Secondary cytoreductive surgery including rectosigmoid colectomy for recurrent ovarian cancer: operative technique and clinical outcome.
OBJECTIVE
To describe the operative technique and associated clinical outcomes of patients undergoing rectosigmoid colectomy as a component of secondary cytoreductive surgery for recurrent ovarian cancer.


METHODS
Consecutive patients undergoing rectosigmoid colectomy for recurrent epithelial ovarian cancer between 1/01 and 12/07 were retrospectively identified and clinical data abstracted from the medical record. The surgical technique, associated morbidity, and clinical outcomes are described.


RESULTS
Fifty-six patients were identified. The median age at secondary surgery was 56 years; 78.6% had advanced-stage disease at initial diagnosis; 69.6% had grade 3 tumors; 73.2% had serous histology. Complete cytoreduction to no gross residual disease was achieved in 85.7% of cases. Concurrent distal ureterectomy/partial cystectomy was required in 8 cases (14.3%). The median number of regional cytoreductive procedures outside the pelvis was 1 (range=0-4). A stapled coloproctostomy was performed in 98.2% of patients; a protective colostomy/ileostomy was constructed in 7 cases (12.5%), and one patient (1.8%) underwent end colostomy. The median EBL was 500 cm(3) and the median operative time was 225 min. Blood transfusion was administered to 48.2% of patients. Post-operative morbidity occurred in 23.2% of patients, with a bowel fistula rate of 5.4% and a mortality rate of 1.8%. The median LOS was 9 days. Post-operative platinum-based chemotherapy was administered in 73.2% of patients. The median overall survival time from secondary surgery was 38.4 months.


CONCLUSIONS
Rectosigmoid colectomy can contribute significantly to a maximal cytoreductive surgical effort for recurrent ovarian cancer. Despite technical differences, including a frequent requirement for resection of the distal urinary tract, morbidity is comparable to rectosigmoid colectomy performed for primary cytoreduction and the associated survival outcome appears favorable.
Bristow
Robert E
RE
The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, MD 21287, USA. rbristo1@jhmi.edu
Peiretti
Michele
M
Gerardi
Melissa
M
Zanagnolo
Vanna
V
Ueda
Stefanie
S
Diaz-Montes
Teresa
T
Giuntoli
Robert L
RL
Maggioni
Angelo
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome