title: En-bloc pelvic resection with concomitant rectosigmoid colectomy and immediate anastomosis as part of primary cytoreductive surgery for patients with advanced ovarian cancer.
abstract: OBJECTIVE
  To assess the authors' experiences in en bloc pelvic resection with concomitant rectosigmoid colectomy and primary anastomosis as a part of primary cytoreductive surgery for patients with advanced ovarian cancer.
  
  
  METHODS
  Atotal of 22 patients with FIGO Stage IIB-IV epithelial ovarian cancer who underwent en bloc pelvic resection with anastomosis were retrospectively reviewed. Data analyses were carried out using SPSS 10.0 and descriptive statistics, Kaplan-Meier survival curves, and Log Rank (Mantel-Cox) test were used for statistical estimations.
  
  
  RESULTS
  Median age was 58.8 years. FIGO stage distribution of the patients was; one (4.5%) IIB, three (13.7%) IIC, three (13.7%) IIIA, six (27.3%) IIIB, and nine (40.9%) IIIC. Median peritoneal cancer index (PCI) was 8 (range 5-22) and optimal cytoreduction was achieved in 18 patients (81.8%) of whom 13 (59.1%) had no macroscopic residual disease (complete cytoreduction). There was no perioperative mortality. A total of nine complications occurred in seven (31.8%) patients. Anastomotic leakage was observed in one (4.5%) patient. There was no re-laparotomy. Mean follow-up time was 60 months. There were 15 (68.2%) recurrences of which 12 (80%) presented in extra-pelvic localizations. Mean disease-free survival (DFS) and overall survival (OVS) were estimated as 43.6 and 50.5 months, respectively. Patients with complete cytoreduction had a better DFS (p = 0.006) and OVS (p = 0.003) than those with incomplete cytoreduction.
  
  
  CONCLUSIONS
  En bloc pelvic resection, as a part of surgical cytoreduction, seems to be a safe and effective procedure in many patients with advanced ovarian cancer if required. Despite relatively high general complication rate, anastomosis-related morbidity of this procedure is low as 0.8%. Nevertheless, surgical plan and perioperative care should be personalized according to medical and surgical conditions of the patient.
authors.forename: Y
authors.initials: Y
authors.lastname: Yildirim
authors.forename: I E
authors.initials: IE
authors.lastname: Ertas
authors.forename: U
authors.initials: U
authors.lastname: Nayki
authors.forename: P
authors.initials: P
authors.lastname: Ulug
authors.forename: C
authors.initials: C
authors.lastname: Nayki
authors.forename: I
authors.initials: I
authors.lastname: Yilmaz
authors.forename: E
authors.initials: E
authors.lastname: Gultekin
authors.forename: A
authors.initials: A
authors.lastname: Dogan
authors.forename: A
authors.initials: A
authors.lastname: Aykas
authors.forename: S
authors.initials: S
authors.lastname: Ulug
authors.forename: A
authors.initials: A
authors.lastname: Ozdemir
authors.forename: U
authors.initials: U
authors.lastname: Solmaz
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods; D010385:Pelvic Exenteration / Q000379:methods*; D010537:Peritoneum / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000379:methods; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome