title: Prognostic role of bowel involvement in optimally cytoreduced advanced ovarian cancer: a retrospective study.
abstract: BACKGROUND
  Optimal debulking surgery is postulated to be useful in survival of ovarian cancer patients. Some studies highlighted the possible role of bowel surgery in this topic. We wanted to evaluate the role of bowel involvement in patients with advanced epithelial ovarian cancer who underwent optimal cytoreduction.
  
  
  METHODS
  Between 1997 and 2004, 301 patients with advanced epithelial cancer underwent surgery at Department of Gynecological Oncology of Centro di Riferimento Oncologico (CRO) National Cancer Institute Aviano (PN) Italy. All underwent maximal surgical effort, including bowel and upper abdominal procedure, in order to achieve optimal debulking (R < 0.5 cm). PFS and OS were compared with residual disease, grading and surgical procedures.
  
  
  RESULTS
  Optimal cytoreduction was achieved in 244 patients (81.0%); R0 in 209 women (69.4.%) and R < 0.5 in 35 (11.6%). Bowel resection was performed in 116 patients (38.5%): recto-sigmoidectomy alone (69.8%), upper bowel resection only (14.7%) and both recto-sigmoidectomy and other bowel resection (15.5%). Pelvic peritonectomy and upper abdomen procedures were carried out in 202 (67.1%) and 82 (27.2%) patients respectively. Among the 284 patients available for follow-up, PFS and OS were significantly better in patients with R < 0.5. Among the 229 patients with optimal debulking (R < 0.5), 137 patients (59.8%) developed recurrent disease or progression. In the 229 R < 0.5 group, bowel involvement was associated with decreased PFS and OS in G1-2 patients whereas in G3 patients OS, but not PFS, was adversely affected. In the 199 patients with R0, PFS and OS were significantly better (p < 0.01) for G1-2 patients without bowel involvement whereas only significant OS (p < 0.05) was observed in G3 patients without bowel involvement versus G3 patients with bowel involvement.
  
  
  CONCLUSIONS
  Optimal cytoreduction (R < 0.5 cm and R0) is the most important prognostic factor for advanced epithelial ovarian cancer. In the optimally cytoreduced (R < 0.5 and R0) patients, bowel involvement is associated with dismal prognosis for OS both in patients with G1-2 grading and in patients with G3 grading. Bowel involvement in G3 patients, carries instead the same risk of recurrence for PFS.
authors.affiliation: Department of Gynecological Oncology of Centro di Riferimento Oncologico (CRO) National Cancer Institute, via Gallini 2, I-33019 Aviano, (PN), Italy. ggiorda@cro.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.forename: Emilio
authors.initials: E
authors.lastname: Lucia
authors.forename: Roberto
authors.initials: R
authors.lastname: Sorio
authors.forename: Valentina E
authors.initials: VE
authors.lastname: Bounous
authors.forename: Francesco
authors.initials: F
authors.lastname: Sopracordevole
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Gustavo
authors.initials: G
authors.lastname: Baldassarre
authors.forename: Elio
authors.initials: E
authors.lastname: Campagnutta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult