Secondary cytoreductive surgery including rectosigmoid colectomy for recurrent ovarian cancer: Operative technique and clinical outcome

Objective. To describe the operative technique and associated clinical outcomes of patients undergoing rectosigmoid colectomy as a component of secondary cytoreductive surgery for recurrent ovarian cancer. Methods. Consecutive patients undergoing rectosigmoid colectomy for recurrent epithelial ovarian cancer between 1/01 and 12/07 were retrospectively identified and clinical data abstracted from the medical record. The surgical technique, associated morbidity, and clinical Outcomes are described. Results. Fifty-six patients were identified. The median age at secondary Surgery was 56 years; 78.6% had advanced-stage disease at initial diagnosis; 69.6% had grade 3 tumors: 73.2% had serous histology. Complete cytoreduction to no gross residual disease was achieved in 85.7% of cases. Concurrent distal ureterectomy/partial cystectomy was required in 8 cases (14.3%). The median number of regional cytoreductive procedures Outside the pelvis was 1 (range = 0-4). A stapled coloproctostomy was performed in 98.2% of patients; a protective colostomy/ileostomy was constructed in 7 cases ( 12.5%), and one patient (1.8%) underwent end colostomy. The median EBL was 500 cm(3) and the median operative time was 225 min. Blood transfusion was administered to 48.2% of patients. Post-operative morbidity Occurred in 23.2% of patients, with a bowel fistula rate of 5.4% and a mortality rate of 1.8%. The median LOS was 9 days. Post-operative platinum-based chemotherapy was administered in 73.2% of patients. The median overall survival time from secondary surgery was 38.4 months. Conclusions. Rectosigmoid colectomy can contribute significantly to a maximal cytoreductive surgical effort for recurrent ovarian cancer. Despite technical differences, including a frequent requirement for resection of the distal urinary tract, morbidity is comparable to rectosigmoid colectomy performed for primary cytoreduction and the associated survival outcome appears favorable. (C) 2009 Elsevier Inc. All rights reserved.