Surgical Outcomes of Epithelial Ovarian Cancer Patients Who Underwent Intestinal Resection During Primary and Secondary Cytoreductive Surgery

Öz

Aim: To compare the surgical outcomes of intestinal resections performed during the primary and secondary cytoreductive surgery of epithelial ovarian cancer.Material And Methods: Epithelial ovarian cancer patients who undergone intestinal resection during primary and secondary cytoreductive surgery between January 2009 and December 2017 were retrospectively evaluated with regard to stage, age, surgical operation, type of intestinal resection, anastomosis/ostomy, operation time period, intraoperative transfusion, preoperative albumin level, presence of ascites and level, performance status, intaoperative and postoperative complications.Results: Totally 40 patients who underwent primary n=22 and secondary n=18 cytoreductive surgery were evaluated. Despite no difference in types of intestinal resection between the groups, low anterior resection 5/22, 22.7% and ileal resection 8/18, 44.4% were the most common intestinal resection procedures in primary and secondary cytoreductive surgery group respectively. When radical operations except from intestinal resection were compared between the groups, patients who undergone secondary cytoreductive surgery had statistically significant more radical operations 24 to 14 respectively, p=0.01 . Specifically, tumor excision from lesser sac 3/24 to 0/14, p=0.046 and peritonectomy 6/24 to 1/14, p=0.037 were more commonly performed radical procedures in the secondary cytoreductive surgery group. There was not any difference in the intraoperative and postoperative complication rates.Conclusion: During primary and secondary cytoreductive surgery, to achieve optimal debulking intestinal resection and other radical procedures could be performed without high complication rates.

Anahtar Kelimeler

• Ovarian cancer,cytoreduction,bowel,complication,radical

Primer ve Sekonder Sitoredüktif Cerrahi Sırasında İntestinal Rezeksiyon Uygulanan Epitelyal Over Kanseri Olgularında Cerrahi Sonuçların Karşılaştırılması

Öz

Giriş: Epitelyal over kanseri nedeniyle uygulanan primer ve sekonder sitoredüksiyon sırasında gerçekleştirilen intestinal rezeksiyonların cerrahi sonuçlarını karşılaştırmak.Gereç ve Yöntemler: Ocak 2009 ve Aralık 2017 tarihleri arasında primer ve sekonder sitoredüktif cerrahi esnasında intestinal rezeksiyon yapılmış epitelyal over kanseri hastaları; hastalık evresi, yaş, yapılan cerrahi işlemler, intestinal rezeksiyon tipi, anastomoz/stoma durumu, ameliyat süresi, intraoperatif transfüzyon gereksinimi, preoperatif albumin düzeyi, asit varlığı ve miktarı, performans durumu, intraoperatif ve postoperatif komplikasyonlar yönünden retrospektif olarak karşılaştırıldı.Bulgular: Primer sitoredüksiyon n=22 ve sekonder sitoredüksiyon n=18 uygulanan toplam 40 hasta değerlendirildi. Uygulanan intestinal rezeksiyon prosedürleri açısından her iki grup arasında anlamlı fark olmamakla beraber, primer sitoredüksiyon grubunda en çok low anterior rezeksiyon 5/22, %22,7 , sekonder sitoredüksiyon grubunda ise en çok ileum rezeksiyonunun 8/18, %44,4 uygulandığı saptandı. İntestinal rezeksiyon dışında yapılmış olan radikal cerrahi işlemler karşılaştırıldığında, sekonder sitoredüksiyon grubunda istatistiksel olarak anlamlı derecede daha fazla sayıda cerrahi işlem yapıldığı gözlendi. Radikal prosedürler arasında lesser sac’tan tümör eksizyonu ve peritonektominin sekonder sitoredüksiyon grubunda daha sık yapıldığı belirlendi. İntraoperatif ve postoperatif komplikasyonlar açısından iki grup arasında anlamlı farklılık saptanmadı.Sonuç: Primer ve sekonder sitoredüktif cerrahi sırasında optimal sitoredüksiyon elde etmek amacıyla intestinal rezeksiyonlar ve buna eşlik eden radikal cerrahi prosedürler yüksek komplikasyon oranları oluşturmadan uygulanabilir.

Anahtar Kelimeler

• Over kanseri,sitoredüksiyon,barsak,komplikasyon,radikal

Kaynakça

1. Lengyel E. Ovarian cancer development and metastasis. Am J Pat- hol2010;177:1053-64.
2. Cannistra SA. Cancer of the ovary. N Engl J Med2004;351:2519-29.
3. du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively ran- domized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynae- kologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO). Cancer2009;115:1234-44.
4. Chang SJ, Bristow RE, Chi DS, Cliby WA. Role of aggressive surgical cyto- reduction in advanced ovarian cancer. J Gynecol Oncol2015;26:336-42.
5. Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Poynor EA, Ag- hajanian C, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol2006;103:1083-90.
6. Prader S, Harter P, Grimm C, Traut A, Waltering KU, Alesina PF, et al. Surgical management of cardiophrenic lymph nodes in patients with ad- vanced ovarian cancer. Gynecol Oncol2016;141:271-5.
7. Plotti F, Montera R, Aloisi A, Scaletta G, Capriglione S, Luvero D, et al. Total rectosigmoidectomy versus partial rectal resection in primary debulking surgery for advanced ovarian cancer. Eur J Surg Oncol2016;42:383-90.
8. Giorda G, Gadducci A, Lucia E, Sorio R, Bounous VE, Sopracordevole F, et al. Prognostic role of bowel involvement in optimally cytoreduced advanced ovarian cancer: a retrospective study. J Ovarian Res2014;7:72.

9. Terzioglu SG, Kilic MO, Cetinkaya N, Baser E, Gungor T, Adiguzel C. The outcomes of intestinal resection during debulking surgery for ovarian cancer. Turk J Surg2017;33:96-9.
10. Bristow RE, Peiretti M, Gerardi M, Zanagnolo V, Ueda S, Diaz-Montes T, et al. Secondary cytoreductive surgery including rectosigmoid colectomy for recurrent ovarian cancer: operative technique and clinical outcome. Gynecol Oncol2009;114:173-7.
11. Hoffman MS, Zervose E. Colon resection for ovarian cancer: intraoperati- ve decisions. Gynecol Oncol2008;111:S56-65.
12. Hoffman MS, Griffin D, Tebes S, Cardosi RJ, Martino MA, Fiorica JV, et al. Sites of bowel resected to achieve optimal ovarian cancer cytoredu- ction: implications regarding surgical management. Am J Obstet Gyne- col2005;193:582-6; discussion 6-8.
13. Tamussino KF, Lim PC, Webb MJ, Lee RA, Lesnick TG. Gastrointestinal surgery in patients with ovarian cancer. Gynecol Oncol2001;80:79-84.
14. Bristow RE, del Carmen MG, Kaufman HS, Montz FJ. Radical oophorec- tomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg2003;197:565-74.
15. Yildirim Y, Ertas IE, Nayki U, Ulug P, Nayki C, Yilmaz I, et al. En-bloc pel- vic resection with concomitant rectosigmoid colectomy and immediate anastomosis as part of primary cytoreductive surgery for patients with advanced ovarian cancer. Eur J Gynaecol Oncol2014;35:400-7.
16. Lago V, Flor B, Matute L, Padilla-Iserte P, Garcia-Granero A, Bustamante M, et al. Ghost Ileostomy in Advanced Ovarian Cancer: A Reliable Option. Int J Gynecol Cancer2018.
17. Kalogera E, Nitschmann CC, Dowdy SC, Cliby WA, Langstraat CL. A pros- pective algorithm to reduce anastomotic leaks after rectosigmoid resecti- on for gynecologic malignancies. Gynecol Oncol2017;144:343-7.
18. Tseng JH, Suidan RS, Zivanovic O, Gardner GJ, Sonoda Y, Levine DA, et al. Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes. Gynecol On- col2016;142:217-24.
19. Rondelli F, Reboldi P, Rulli A, Barberini F, Guerrisi A, Izzo L, et al. Loop ileos- tomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis2009;24:479-88.
20. Bristow RE, Peiretti M, Zanagnolo V, Salani R, Giuntoli RL, 2nd, Maggioni A. Transverse colectomy in ovarian cancer surgical cytoreduction: opera- tive technique and clinical outcome. Gynecol Oncol2008;109:364-9.
21. Harter P, du Bois A, Hahmann M, Hasenburg A, Burges A, Loibl S, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gy- naekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg On- col2006;13:1702-10.
22. Harter P, Sehouli J, Reuss A, Hasenburg A, Scambia G, Cibula D, et al. Prospective validation study of a predictive score for operability of re- current ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer2011;21:289-95.
23. Harter P, Hahmann M, Lueck HJ, Poelcher M, Wimberger P, Ortmann O, et al. Surgery for recurrent ovarian cancer: role of peritoneal carcino- matosis: exploratory analysis of the DESKTOP I Trial about risk factors, surgical implications, and prognostic value of peritoneal carcinomatosis. Ann Surg Oncol2009;16:1324-30.
24. Aletti GD, Santillan A, Eisenhauer EL, Hu J, Aletti G, Podratz KC, et al. A new frontier for quality of care in gynecologic oncology surgery: mul- ti-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. Gynecol Oncol2007;107:99-106.
25. Hacker NF. State of the art of surgery in advanced epithelial ovarian can- cer. Ann Oncol2013;24 Suppl 10:x27-32.
26. Wright JD, Lewin SN, Deutsch I, Burke WM, Sun X, Neugut AI, et al. Defining the limits of radical cytoreductive surgery for ovarian cancer. Gynecol Oncol2011;123:467-73.
27. Patankar S, Burke WM, Hou JY, Tergas AI, Huang Y, Ananth CV, et al. Risk stratification and outcomes of women undergoing surgery for ovarian cancer. Gynecol Oncol2015;138:62-9.
28. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis2004;6:462-9.
29. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg2005;92:1150-4.
30. Fotopoulou C, Jones BP, Savvatis K, Campbell J, Kyrgiou M, Farthing A, et al. Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities. Arch Gynecol Obs- tet2016;294:607-14.