Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer Journal Article


Authors: Mourton, S. M.; Temple, L. K.; Abu-Rustum, N. R.; Gemignani, M. L.; Sonoda, Y.; Bochner, B. H.; Barakat, R. R.; Chi, D. S.
Article Title: Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer
Abstract: Objectives. Studies from the colorectal literature have shown that factors associated with anastomotic leak after colorectal resection include long surgical time (>2 h), multiple blood transfusions, and short distance to the anal verge. The aim of this study was to assess the morbidity associated with en bloc resection of ovarian carcinoma with low anterior resection and anastomosis in patients undergoing primary cytoreductive surgery for advanced disease. Methods. We performed a retrospective chart review of all patients who had undergone primary cytoreduction for advanced epithelial ovarian cancer with rectosigmoid resection followed by low rectal anastomosis between January 1994 and June 2004. Patient characteristics, operative details, and postoperative complications were extracted from patients' charts. Results. Seventy patients met the above criteria and form our study group. The median age was 59 years (range, 25-82). There were 52 stage IIIC (74%) and 18 stage IV (26%) cancers. The median operating time was 315 min (range, 120-750) and the median estimated blood loss was 1200 ml (range, 250-8000), with 53 (76%) patients requiring blood transfusion. Twenty-eight patients (40%) underwent major upper abdominal procedures other than omentectomy, and 14 patients (20%) underwent a second bowel resection. Twelve patients (17%) underwent a protective ileostomy while the remainder (83%) did not. Of the 58 patients with no ostomy, the only complications associated with the resection and anastomoses were a pelvic abscess in 3 patients (5%) and an anastomotic leak requiring diverting colostomy in 1 patient (1.7%). Of the 12 patients who had protective ileostomies, 3 (25%) had complications related to their ileostomy short-bowel syndrome requiring early reversal, incarceration of the prolapsed loop requiring surgical correction, and prolapse corrected electively at the time of second-look surgery. Conclusions. In women undergoing primary cytoreductive surgery, the morbidity associated with en bloc resection of ovarian carcinoma with low rectosigmoid resection and anastomosis without protective ileostomy was acceptably low, with an anastomotic leak rate of less than 2%. Protective ileostomy is not always necessary and should be used selectively. © 2005 Elsevier Inc. All rights reserved.
Keywords: adult; controlled study; aged; aged, 80 and over; middle aged; cancer surgery; surgical technique; retrospective studies; major clinical study; advanced cancer; conference paper; cancer patient; cytoreductive surgery; ovarian neoplasms; demography; bleeding; morbidity; retrospective study; postoperative complication; disease severity; operation duration; medical record; reoperation; ileostomy; ovary carcinoma; blood transfusion; epithelial cells; intestine resection; abdominal surgery; epithelial ovarian cancer; anastomosis; tissue injury; short bowel syndrome; anastomosis, surgical; rectum; colostomy; elective surgery; anastomosis leakage; pelvis abscess; omentum; anastomotic leak; low anterior resection; colon, sigmoid; rectosigmoid resection; rectum anastomosis
Journal Title: Gynecologic Oncology
Volume: 99
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2005-12-01
Start Page: 608
End Page: 614
Language: English
DOI: 10.1016/j.ygyno.2005.07.112
PUBMED: 16153697
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 58" - "Export Date: 24 October 2012" - "CODEN: GYNOA" - "Source: Scopus"
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MSK Authors
  1. Richard R Barakat
    629 Barakat
  2. Dennis S Chi
    598 Chi
  3. Mary L Gemignani
    195 Gemignani
  4. Yukio Sonoda
    371 Sonoda
  5. Bernard Bochner
    405 Bochner
  6. Larissa Temple
    192 Temple