Survival impact of multiple bowel resections in patients undergoing primary cytoreductive surgery for advanced ovarian cancer: A case-control study

Objective.: To evaluate clinicopathological factors and survival outcome of patients with advanced epithelial ovarian carcinoma undergoing multiple bowel resections to achieve optimal (≤ 1 cm) cytoreduction. Methods.: A case-control study was performed identifying patients undergoing optimal primary cytoreductive surgery with ≥ 2 bowel resections between 10/1997 and 2/2006. The two control groups consisted of (1) patients undergoing optimal cytoreduction with ≤ 1 bowel resections matched [1:2] for age and stage and (2) patients left with suboptimal disease. Cox proportional hazards model were used to evaluate the effects of demographic and surgico-pathologic factors on survival outcome. Results.: A total of 34 patients underwent ≥ 2 bowel resections. Sixty-eight patients underwent ≤ 1 bowel resections. All patients had optimal cytoreduction and 40/102 patients (39.2%) underwent complete cytoreduction. Patients undergoing multiple bowel resections experienced a higher EBL (700 v 500 mL, p = 0.01) and longer LOS (10 v 7 days, p = 0.01) compared to patients with ≤ 1 bowel resections. Multivariate analysis revealed the amount of residual disease to be a statistically significant and radiation therapy to the right pelvic sidewall and cul-de-sac independent predictor of overall survival. The median overall survival time for patients undergoing ≥ 2 bowel resections was 28.3 months, which was comparable to patients undergoing ≤ 1 bowel resections, (37.8 months, p = 0.09) but statistically significantly superior to patients left with suboptimal residual disease (12 months, p = 0.02). Conclusions.: Although primary surgery that includes ≥ 2 bowel resections is associated with longer LOS and a higher EBL, such extensive procedures are warranted if they will contribute to an overall optimal residual disease state.