Anastomosis Is Possible with an Acceptable Low Rate of Complications Compared to a Diverting Stoma in Surgery for Ovarian Cancer
Journal of Cancer Treatment and Research
Volume 7, Issue 2, June 2019, Pages: 28-32
Received: Mar. 10, 2019;
Accepted: Apr. 25, 2019;
Published: Jun. 5, 2019
Views 327 Downloads 54
Vibe Munk Bertelsen, Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
Gitte Ørtoft Lykkegård, Department of Gynecology and Obstetrics, Copenhagen University Hospital, Copenhagen, Denmark
Lone Kjeld Petersen, Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
Follow on us
Radical surgery for advanced stage of ovarian cancer may lead to bowel resection and consequently either an anastomosis or a diverting stoma. This study investigates whether it is possible to find selection criteria which predict benefits from an anastomosis compared to a diverting stoma, in order to prevent complications and leakage. Consecutive patients with ovarian/tuba/peritoneal cancer undergoing initial bowel resection at Aarhus University Hospital, Denmark, between March 2012 and December 2015 were retrospectively identified. Among 67 patients with bowel resections, 32 patients had a stoma and 35 patients had an anastomosis. No significant differences were observed in the two groups regarding age, BMI, smoking, ASA classification, FIGO stage, plasma albumin, the ability to undergo radical surgery, or time to initiate chemotherapy. The length of hospital stay was longer for patients with a stoma (P=0.01). An anastomotic leakage lead to reoperation for 8.6% of the anastomosis patients. Patients who were reoperated due to leakage, initiated chemotherapy after 21-45 days. Only smoking was identified as a preoperative risk factor for leakage after bowel anastomosis in relation to debulking surgery for ovarian cancer. The complication rate among patients with an anastomosis was acceptably low, and the time from surgery to start of chemotherapy was the same as in patients with a stoma. This study supports the hypothesis that an anastomosis can be safely performed in patients with advanced ovarian cancer.
Ovarian Cancer, Bowel Resection, Anastomotic Leakage, Stoma, Selection Criteria
To cite this article
Vibe Munk Bertelsen,
Gitte Ørtoft Lykkegård,
Lone Kjeld Petersen,
Anastomosis Is Possible with an Acceptable Low Rate of Complications Compared to a Diverting Stoma in Surgery for Ovarian Cancer, Journal of Cancer Treatment and Research.
Vol. 7, No. 2,
2019, pp. 28-32.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
NORDCAN (Nordic Cancer database program). Updated December 2017. http://www-dep.iarc.fr/NORDCAN/English/frame.asp
DGCD annual Report 2016-2017. http://www.dgcg.dk/index.php/arsrapport
Kirsten Jochumsen K., Larsen S., and Neumann G. November 2016. https://www.sundhed.dk/sundhedsfaglig/information-til-praksis/syddanmark/almen-praksis/patientforloeb/icpc-oversigt/x-kvindelige-koensorganger-inkl-mammae/ovariecancer/
Vitale SG, Marilli I, Lodato M, and Tropea A, and Cianci A. “The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review.” Updates Surg. 2013 Dec; 65(4):265-70. doi: 10.1007/s13304-013-0213-4. Epub 2013 May 8
Schorge J. O., McCann C., and Del Carmen MG. “Surgical Debulking of Ovarian Cancer: What Difference Does It Make?”. Rev Obstet Gynecol. 2010 Summer;3(3):111-7
O’Leary D. P., Fide C. J., Foy C, and Lucarotti M. E. “Quality of life after low anterior resection with total mesorectal excision and temporary loopileostomy for rectal carcinoma”. Br J Sung. 2001 Sep;88(9):1216-20
Mourton S. M., Temple L. K., Abu-Rustum N. R., Gemignani M. L., Sonoda Y., Bochner B. H, et al. “Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer”. Gynecol Oncol. 2005 Dec; 99(3):608-14. Epub 2005 Sep 8
Kim H. S., Kim E. N., and Jeong S. Y. “Comparison of the efficacy of low anterior resection with primary anastomosis and Hartmann's procedure in advanced primary or recurrent epithelial ovarian cancer”. Eur J Obstet Gynecol Reprod Biol. 2011 Jun; 156(2):194-8. doi: 10.1016/j.ejogrb.2011.01.003. Epub 2011 Feb 2
Grimm C., Harter P., Alesina P. F., Prader S., Schneider S., Ataseven B., et al.. ”The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery”. Gynecol Oncol. 2017 Sep; 146(3):498-503. doi: 10.1016/j.ygyno.2017.06.007. Epub 2017 Jun 10
Bartl T., Schwameis R., Stift A., Bachleitner-Hofmann T., Reinthaller A., Grimm C., et al. “Predictive and Prognostic Implication of Bowel Resections During Primary Cytoreductive Surgery in advanced Epithelial Ovarian Cancer”. Int J Gynecol Cancer. 2018 Nov; 28(9):1664-1671. doi: 10.1097/IGC.0000000000001369
Richardson D. L., Marian A., and Cliby W. A. “Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer”. Gynecol. Oncol. 2006 Nov; 103(2):667-72. Epub 2006 Jun 23
Wu S. W., Ma C. C., and Yang Y. “Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis”. World J Gastroenterol. 2014 Dec 21; 20(47):18031-7. doi: 10.3748/wjg.v20.i47.18031
Schmidt O, Merkel S, and Hohenberger W. “Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing”. Eur J Surg Oncol 2003 Apr;29(3):239-43