Colorectal intervention as part of surgery for patients with gynaecological malignancy

Objective: This study was conducted to determine the indications for and outcome of colorectal intervention in patients with advanced gynaecological malignancy. Methods: Between January 1999 and June 2004, 27 gynaecological cancer patients underwent 36 colorectal intervention performed by general surgeons. The 36 operations were associated with 14 (39%) primary surgical procedures, 9 (25%) second-look laparotomies, and 13 (36%) procedures for recurrence or palliation. Results: The mean age was 56 years (range 32-83 years). The majority of operations were performed in patients with ovarian (67%), endometrial (18%) and cervical (15%) malignancy. The primary indications for colorectal resection was tumor cytoreduction in 56% of the 36 operations. Other indications included repair of iatrogenic bowel injuries (n = 9, 25%), resection for multiple iatrogenic enterotomies (n = 4, 11%), and bowel obstruction (n = 33, 8%). The most frequently performed bowel operation was rectosigmoid resection with end-to-end anastomosis (n = 19, 53%). Colostomy, was performed in 14% of the rectosigmoid resections at primary surgery. Small-bowel resection was required in 31% of the 36 operations. postoperative complications included Wound complications (14%), pulmonary infections (8%), cardiac complications (6%) and intra-abdominal abscess (6%). There was a single surgical mortality (3%). Conclusion: Colorectal intervention is frequently indicated during operations for advanced gynaecological malignancy, and they are associated with a significant rate of postoperative complications. Specialists operating on gynaecological malignancy should have the technical skills necessary to perform these procedures.