title: Rectosigmoid resection at the time of primary cytoreduction for advanced ovarian cancer. A multi-center analysis of surgical and oncological outcomes.
abstract: OBJECTIVE
  The aim of the study was to determine the impact of rectosigmoid resection, at the time of primary cytoreductive surgery, on morbidity and survival of patients with advanced ovarian cancer.
  
  
  METHODS
  We performed a retrospective medical chart review of patients who underwent rectosigmoid resection for ovarian, tubal and peritoneal cancers between 1998 and 2008 at the IEO in Milan and JHMI in Baltimore. Perioperative and follow-up data were collected.
  
  
  RESULTS
  A total of 238 patients were identified; 180 (75%) had stages IIC-IIIC and 58 (25%) had stage IV. Complete cytoreduction was achieved in 41% of the cases. Stapled coloproctostomy was performed in 98% while hand sewn in only 2%; a protective ileostomy and colostomy were necessary (constructed) in 2 (0.8%) and 5 (2%) cases respectively. The complications associated to rectosigmoid resection were anastomotic leakage in 7 (3%) patients and pelvic abscess in 9 (3.7%). Fifty percent of patients recurred during the study period, but only 5% of them showed a relapse at the level of the pelvis whereas 8% presented with abdominal recurrence associated with pelvic disease as well. The median overall survival time among patients with complete cytoreduction was 72 months compared with 42 months among the rest of patients (p=0.002).
  
  
  CONCLUSIONS
  Rectosigmoid colectomy may significantly contribute to achieve a complete primary cytoreduction for advanced stage ovarian, tubal and peritoneal cancers. Pelvic complete debulking accomplished by rectosigmoid resection could be associated with a lower rate of pelvic recurrence as well.
authors.affiliation: Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy. michele.peiretti@ieo.it
authors.forename: Michele
authors.initials: M
authors.lastname: Peiretti
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zapardiel
authors.forename: Melissa
authors.initials: M
authors.lastname: Gerardi
authors.forename: Vanna
authors.initials: V
authors.lastname: Zanagnolo
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.forename: Luca
authors.initials: L
authors.lastname: Bocciolone
authors.forename: Giovanni Damiano
authors.initials: GD
authors.lastname: Aletti
authors.forename: Angelo
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult