Gastrointestinal surgery in patients with ovarian cancer

Objectives: The objectives were to assess indications for and outcome and morbidity of gastrointestinal surgery in patients with ovarian cancer.

Methods: We reviewed 364 patients with ovarian cancer who underwent a total of 491 operations including a gastrointestinal procedure over a 10-year period. The 491 operations comprised 180 primary surgical procedures (37%), 44 second-look laparotomies (9%), and 267 procedures for recurrence or palliation (54%).

Results: Debulking of disease was the indication for bowel surgery for 87, 45, and 62% of cases in the three groups, respectively. Bowel obstruction was an indication in 14% of patients at primary surgery and in 34% at secondary surgery (P < 0.05). Rectosigmoid resection was the most common bowel operation overall, particularly in the primary surgery group (65%). Colostomy was performed in 30% of the cases of rectosigmoid resection at primary surgery. Small-bowel resection was most common in the surgery for recurrence or palliation group. The blood transfusion rate was 79%. Febrile morbidity was the most common complication overall (29%), with no significant differences among groups. Four patients (0.8%) required reoperation for an abscess or anastomotic leak. Nineteen operations (3.9%) were followed by death within 30 days, with no significant differences among groups. A weighted Cox model estimated that 21, 42, and 11% of patients would be alive 5 years after primary surgery, second-look laparotomy, and surgery for recurrence or palliation, respectively (P = 0.01).

Conclusion: Gastrointestinal surgery is frequently indicated during operations for ovarian cancer. Gynecologic cancer surgeons should be trained accordingly. Patients with possibly malignant ovarian masses should receive preoperative bowel preparation and be counseled that bowel surgery may be needed but colostomy is not frequently required.