The role of bowel surgery with cytoreduction for epithelial ovarian cancer

Aims: To assess the efficiency and morbidity associated with bowel resection with the initial cytoreduction procedure for advanced ovarian cancer. Materials and methods: A review was carried of 95 patients with ovarian cancer who underwent cytoreductive surgery between 2000 and 2003. The relationship between dichotomised preoperative, intra-operative and postoperative outcome variables were tested using SPSS software. Kaplan-Meier curves were generated to compare survival. Cox proportional hazards regression was used to determine the independent significance of factors after cytoreductive surgery. Results: In patients in whom bowel resection was carried out, the largest residual tumour mass was < 1 cm in 66.67% of patients, compared with 45.28% of patients undergoing surgery without bowel resection (P = 0.038). The median survival in the optimally debulked patients was 50.38 months compared with 37.15 months in the patients who had suboptimal cytoreduction (P = 0.0021). The median survival in patients undergoing bowel resection was 50.70 months compared with 44.62 months in the patients who had cytoreduction without bowel resection (P = 0.2176). Multivariate analysis showed that optimal cytoreduction (P = 0.005) was found to be independently prognostic for overall survival. Major adverse events, such as ileus, intestinal fistulae, urinary tract fistulae, were not significantly different between groups. Conclusion: Bowel resection is a worthwhile endeavour in selected patients with advanced ovarian cancer to increase therapeutic efficiency. The surgical morbidity rate from these procedures is not serious and seems acceptable.