The importance of lower gastrointestinal tract endoscopy regarding the preoperative evaluation of malignant adnexal masses

Yıl 2020, , 9 - 15, 07.04.2020

Sefa Kurt Hikmet Timur Aras Canda Hasan Saatli Uğur Saygılı

https://doi.org/10.5505/deutfd.2020.47855

Öz

Objective: Our aim in this study was to investigate the value of lower gastrointestinal system (GIS) endoscopy regarding the detection of colon invasion and its importance in recognizing primary and secondary ovarian cancers in cases clinically prediagnosed as advanced stage ovarian cancers.

Materials and Methods: Records of patients, who were operated due to adnexal mass suspicious for malignancy at our clinic between September 2012 and May 2017, were examined. One hundred thirteen cases of advanced stage (Stage III – IV) malignant adnexal masses were detected.

Results: Cases that underwent laparotomy because of a prediagnosis of malignant adnexal mass (mostly ovarian), and had stage III and IV disease, were compared regarding clinical characteristics and foreseeing bowel resection (51 patients had undergone lower GIS endoscopy, 62 had not). Six of the 51 patients, who underwent endoscopy, were diagnosed with colon involvement during endoscopy while 4 other patients were diagnosed intraoperatively. Among the 62 patients, without preoperative endoscopy, 10 patients underwent intraoperative bowel resection. The mean age of the patients with bowel resection was 57.35±13.53y; the mean age of the remaining patients was 55.8±12.54y. Rectosigmoid region was the most common area of resection (17/20). The positive predictive value of colonoscopy for predicting bowel resection was 100%, while the negative predictive value was 91%.

Conclusion: Bowel resection is a pivotal component of the surgical approach to advanced stage malignant adnexal masses. The detection of tumor spread in lower GIS endoscopy is very important while planning the surgery, dealing with postoperative stoma problems and emotional issues and during the differential diagnosis of metastatic tumors.

Anahtar Kelimeler

malignant adnexal mass, bowel resection, colonoscopy

MALİGN ADNEKSİYAL KİTLELERİN PREOPERATİF DEĞERLENDİRMESİNDE ALT GASTROİNTESTİNAL SİSTEM ENDOSKOPİSİNİN ÖNEMİ

Öz

Amaç: Bu çalışmada amacımız; klinik olarak ileri evre over kanseri (OK) düşünülen olgularda, alt gastrointestinal sistem (GİS) endoskopisinin; kolon invazyonunu saptamadaki değerini ve ayrıca primer sekonder OK ayrımındaki önemini araştırmaktır.

Gereç ve Yöntem: Eylül 2012 – Mayıs 2017 yıllarında, DEÜTF Hastanesinde opere edilen ve DSÖ ICD-10 2016 versiyonuna göre malign adneksiyal kitle tanısı kodlanan ve laparotomi uygulanan, ileri evre (evre III-IV) 113 olgunun dosya kayıtları alt GİS endoskopisi uygulananlar ve uygulanmayanlar olarak karşılaştırıldı.

Bulgular: Malign adneksiyal (en sık over) kitle ön tanısıyla laparotomi uygulanan, evre III- IV,113 olgu, klinik özellikler ve barsak rezeksiyonunu öngörme açısından (alt GİS endoskopik inceme yapılanlar, 51 olgu, yapılmayanlar, 62 olgu) karşılaştırıldı. Kolonoskopi yapılan grupta 6 olguda kolon tutulumu gözlendi, 4 olguda tutulum intraoperatif saptandı. Kolonoskopi yapılmayan grupta 10 olguda intraoperatif rezeksiyon uygulandı. İki grupta da 10’ ar olguya barsak rezeksiyonu gerekti. Rezeksiyon yapılan 20 olgunun ortalama yaşı, 57,35 ± 13,53, rezeksiyon yapılmayan 93 olgunun ortalama yaşı 55,81 ± 12,54 tür. En sık rezeksiyon rektosigmoid bölgede olup, (17 olgu) tüm olguların %85’ini oluşturmaktadır. Kolonoskopinin barsak rezeksiyonunu ön görmedeki pozitif prediktif değeri (PPV); %100, negatif prediktif değeri (NPV); %91 olarak bulundu.

Sonuç: İleri evre malign adneksiyal kitlelere cerrahi yaklaşımda alt GİS barsak rezeksiyonları tedavinin önemli bir komponentidir. Alt GİS endoskopisinde tümör tutulumunun saptanması cerrahi tedaviyi planlama, postoperatif dönemde stoma problemleri ve emosyonel sorunlarla baş etmede ve metastatik tümörlerin ayırıcı tanısında önemlidir.

Anahtar Kelimeler

barsak rezeksiyonu, kolonoskopi, malign adneksiyal kitle

Kaynakça

• Miller J, Proietto A. The place of bowel resection in initial debulking surgery for advanced ovarian cancer. Aust N Z J Obstet Gynaecol. 2002;42:535–7.
• Hacker NF, Rao A. Surgery for advanced epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol. 2017;41:71–87.
• Fotopoulou C, Richter R, Braicu EI, Schmidt S-C, Lichtenegger W, Sehouli J. Can complete tumor resection be predicted in advanced primary epithelial ovarian cancer? A systematic evaluation of 360 consecutive patients. Eur J Surg Oncol. 2010; 36:1202–10.
• Ravizza D, Fiori G, Trovato C, Maisonneuve P, Bocciolone L, Crosta C. Is colonoscopy a suitable investigation in the preoperative staging of ovarian cancer patients? Dig Liver Dis. 2005;37:57–61.
• Hertel H, Diebolder H, Herrmann J, Kohler C, Kuhne-Heid R, Possover M, et al. Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer. Gynecol Oncol. 2001; 83:481–4.
• Hoffman MS, Zervose E. Colon resection for ovarian cancer: Intraoperative decisions. Gynecol Oncol. 2008;111(2 SUPPL.):S56–65.
• Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008;44:1105–15.
• Petru E, Kurschel S, Walsberger K, Haas J, Tamussino K, Winter R. Can bowel endoscopy predict colorectal surgery in patients with an adnexal mass? Int J Gynecol Cancer. 2003;13:292–6.
• Lee K-C, Lin H, ChangChien C-C, Fu H-C, Tsai C-C, Wu C-H, et al. Difficulty in diagnosis and different prognoses between colorectal cancer with ovarian metastasis and advanced ovarian cancer: An empirical study of different surgical adoptions. Taiwan J Obstet Gynecol. 2017;56:62–7.
• Uyanikoglu H, Tatli F, Uyanikoglu A. Should colonoscopy screening be performed in patients with adnexal mass? J Turgut Ozal Med Cent. 2017;25:57-9.
• Stewart CJR, Brennan BA, Hammond IG, Leung YC, McCartney AJ. Accuracy of frozen section in distinguishing primary ovarian neoplasia from tumors metastatic to the ovary. Int J Gynecol Pathol. 2005;24:356–62.
• Raś R, Barnaś E, Magierło JS, Drozdzowska A, Bartosiewicz E, Sobolewski M, et al. Preoperative colonoscopy in patients with a supposed primary ovarian cancer. Medicine (Baltimore). 2019;98:e14929.
• Battersby CLF, Hajibandeh S, Hajibandeh S. Oral Antibiotics as Adjunct to Systemic Antibiotics and Mechanical Bowel Preparation for Prevention of Surgical Site Infections in Colorectal Surgery. Do We Really Need More Trials? Dis Colon Rectum. 2018;61(6):e341–2.
• 2017 European Society of Coloproctology (ESCP) Collaborating Group. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis. 2018;20 Suppl 6:15–32.
• Rollins KE, Javanmard-Emamghissi H, Acheson AG, Lobo DN. The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery. Ann Surg. 2019;270:43-58.
• Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, et al. Colorectal cancers not detected by screening flexible sigmoidoscopy in the prostate, lung, colorectal, and ovarian cancer screening trial. Gastrointest Endosc. 2012;75:612–20.
• Laiyemo AO, Doubeni C, Pinsky PF, Doria-Rose VP, Sanderson AK, Bresalier R, et al. Factors associated with inadequate colorectal cancer screening with flexible sigmoidoscopy. Cancer Epidemiol. 2012;36:395–9.
• Horvat N, Raj A, Ward JM, Smith JJ, Markowitz AJ, Gollub MJ. Clinical Value of CT Colonography Versus Preoperative Colonoscopy in the Surgical Management of Occlusive Colorectal Cancer. AJR Am J Roentgenol. 2018;210:333–40.
• National Comprehensive Cancer Network. Ovarian Cancer (Version 3.2019) [Cited: 2019 Dec 27] Available from: https://www.nccn.org/professionals/physician_gls
• Nagata K, Ota Y, Okawa T, Endo S, Kudo SE. PET/CT colonography for the preoperative evaluation of the colon proximal to the obstructive colorectal cancer. Dis Colon Rectum. 2008;5:882–90.
• Suzuki C, Wallgren H, Abraham-Nordling M, Palmer G. Preoperative CT-based predictive factors for resectability and medium-term overall survival in patients with peritoneal carcinomatosis from colorectal cancer. Clin Radiol. 2018;73:756.e11-756.e16.
• Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimot H. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol. 2014;20:16964–75.