title: The use of laparostomy in patients with gynecologic cancer: first report from a UK cancer center.
abstract: OBJECTIVE
  To report on the use of laparostomy after major gynecologic cancer surgery.
  
  
  METHODS
  Operative records and surgical databases of patients who underwent major open abdominal surgery over a 6.5-year period at a tertiary referral center were searched. Patients who had diagnostic procedures, operative laparoscopy, and surgery for vulval cancer were excluded. All patients who had laparostomy were identified; and the diagnosis, indication for laparostomy, method of temporary cover, and complications were recorded.
  
  
  RESULTS
  A total of 1592 laparotomies, including 37 emergencies, were performed. Of these, 14 patients (0.88%) had a laparostomy. Seven patients had primary cancer and 7 had recurrent cancer. As more patients had surgery for primary disease, laparostomy was more common in patients who underwent surgery for recurrent cancer. Seven patients had ovarian/fallopian tube/primary peritoneal cancer, 4 patients had uterine cancer, 2 patients had cervical cancer, and one patient had vaginal cancer. Ten laparostomies (71.4%) were performed after an emergency procedure; thus, laparostomy was approximately 100 times more common after emergency than elective major surgery. Massive bowel distension and bowel wall edema were the major indications for laparostomy. The method of temporary closure was variable, and a sterile saline bag was the most commonly used. The laparostomy was closed in all but 2 patients, most often on postoperative day 2 or 3. Two patients (14.3%) died within 30 days of the laparostomy, and 2 others died at postoperative days 40 and 62. Three of these 4 patients had recurrent cancer, and 2 patients had emergency procedures.
  
  
  CONCLUSIONS
  The overall incidence of laparostomy associated with laparotomy for gynecological cancer surgery was less than 1:100 cases, was more common after surgery for recurrent cancer, and in particular, was approximately 100 times more common after emergency procedures. The 30-day operative mortality rate was 14.3%.
authors.affiliation: Division of Gynaecological Oncology, Royal Marsden Hospital, London, UK.
authors.forename: Sonali
authors.initials: S
authors.lastname: Kaushik
authors.forename: Khurram
authors.initials: K
authors.lastname: Akhter
authors.forename: Barnaby
authors.initials: B
authors.lastname: Rufford
authors.forename: Thomas E J
authors.initials: TE
authors.lastname: Ind
authors.forename: Desiree F
authors.initials: DF
authors.lastname: Kolomainen
authors.forename: John
authors.initials: J
authors.lastname: Butler
authors.forename: Desmond P J
authors.initials: DP
authors.lastname: Barton
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D062606:Tertiary Care Centers; D006113:United Kingdom