title: Douglas peritonectomy compared to recto-sigmoid resection in optimally cytoreduced advanced ovarian cancer patients: analysis of morbidity and oncological outcome.
abstract: BACKGROUND
  Rectosigmoidectomy (RR) with primary anastomosis or pelvic peritonectomy (PP) are often part of an optimal en bloc tumor resection in advanced ovarian cancer (AOC) patients with contiguous extension to or encasement of the reproductive organs, peritoneum of the cul-de-sac and sigmoid colon. We report our experience with two different surgical approaches in optimally cytoreduced AOC patients evaluating oncologic outcome and surgically associated morbidities
  
  
  METHODS
  Data from all consecutive AOC patients undergoing PP or RR as part of the surgical procedure during primary cytoreduction from 2004 through 2009 were extrapolated and analyzed using the chi-squared test, Cox proportional hazard model and Kaplan-Meier method including log-rank test.
  
  
  RESULTS
  During the study period, we identified 187 AOC patients, fitting the inclusion criteria: 71 (38%) were submitted to RR and 116 (62%) were managed with PP. The estimated mean disease-free survival (DFS) was 30.7 months (95% CI 24.6-36.8) in the RR arm vs. 25.9 months in the PP arm (95% CI 21.9-29.9) (p 0.299); similarly, the estimated mean overall survival (OS) was 38.8 months (95% CI 33.4-44.2) in the RR arm and 48.2 months in the PP arm (95% CI 43.1-53.3) (p = 0.122). No statistically significant differences were found in terms of DFS and OS according to the mesocolic lymphnode status (p = 0.65 and p = 0.81, respectively).
  
  
  CONCLUSIONS
  In conclusion, the current study clearly supports evidence that survival rates are similar for patients who achieved optimal residual tumor (RT), independent to whether they had RR or PP.
authors.affiliation: Department of Gynecologic Oncology, Università Cattolica del Sacro Cuore, Rome, Italy. valeriogallotta@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: Gallotta
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.forename: G
authors.initials: G
authors.lastname: Vizzielli
authors.forename: G
authors.initials: G
authors.lastname: Panico
authors.forename: C
authors.initials: C
authors.lastname: Rossitto
authors.forename: M L
authors.initials: ML
authors.lastname: Gagliardi
authors.forename: P A
authors.initials: PA
authors.lastname: Margariti
authors.forename: M G
authors.initials: MG
authors.lastname: Salerno
authors.forename: G F
authors.initials: GF
authors.lastname: Zannoni
authors.forename: F
authors.initials: F
authors.lastname: Pacelli
authors.forename: G
authors.initials: G
authors.lastname: Scambia
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012007:Rectum / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome