Long-term results of bowel resection as a component of cytoreductive surgery for advanced ovarian cancer

Introduction. Ovarian cancer is one of the leading causes of death from cancer of the female reproductive system. Despite the use of modern drugs, patient survival remains unsatisfactory. In this regard, it is necessary to expand the scope of surgical interventions in this category of patients, which is impossible without performing surgery on the small or large intestine.

Aim. To analyze the long-term results of cytoreductive surgery in patients with advanced ovarian cancer involving the small or large intestine in the tumor process.

Materials and methods. Our retrospective study included 105 patients with histologically verified ovarian cancer who were treated from 2005 to 2017 at N. N. Blokhin Russian Cancer Research Center, the operation of which was accompanied by resection of one or another part of the intestine.

Results. Complete cytoreductive surgery with bowel resection was performed in 39.5 % of cases in the group of patients after neoadjuvant chemotherapy and in 28.4 % of cases in the group of patients without preoperative treatment. There was a significant difference in the rates of non-optimal cytoreduction in the groups of patients with and without preoperative chemotherapy, which amounted to 23.7 and 43.3 %, respectively. When analyzing the long-term results of treatment without taking into account the timing of the operation, it was shown that in patients with complete, optimal and non-optimal cytoreduction, the median PFS was 24.8; 15.1, 11.4 months, the median overall survival was 63,0; 54.7; 36.2 months respectively. Survival analysis taking into account the volume and timing of the operation showed that the best PFS rates (33.9 months) were obtained when the operation was performed as сomplete cytoreduction and without previous drug treatment. A decrease in overall survival was demonstrated with increasing size of the residual tumor, regardless of the timing of the operation. When the operation was performed with no residual tumor in the primary and interval cytoreduction groups, the median life expectancy was 62.9 and 63.3 months, with a residual tumor size of less than 1 cm – 54.7 and 50.7 months, more than 1 cm – 37.6 and 34.9 months respectively.

Conclusion. Surgical treatment of patients with advanced ovarian cancer, aimed at the maximum possible removal of the tumor, is inextricably linked with resection parts, including primarily operations on the small or large intestine. Reducing the size of the residual tumor to achieve complete or optimal cytoreductive surgery, which required bowel resection, naturally increases overall survival rates, regardless of the timing of the surgical intervention.

1. Kaprin A.D., Starinsky V.V., Shakhzadova A.O. Malignant neoplasms in Russia in 2021 (incidence and mortality). Moscow: MNIOI imeni P.A. Gerzhena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2022. 252 p. (In Russ.).

2. Griffiths C.T. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Nat Cancer Inst Monograph 1975;42:101–4. PMID: 1234624

3. Bristow R.E., Tomacruz R.S., Armstrong D.K. et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002;20:1248–59. DOI: 10.1200/JCO.2002.20.5.1248

4. Du Bois A., Reuss A., Pujade-Lauraine E. et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009;115(6):1234–44. DOI: 10.1002/cncr.24149

5. Harter Ph., Muallem M.Z., Buhrmann C., Lorenz D. Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. Gynecol Oncol 2011;121(3):615–9. DOI: 10.1016/j.ygyno.2011.02.014

6. Vergote I., Trope C.G., Amant F. et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943–53. DOI: 10.1056/NEJMoa0908806

7. Румянцев А.А., Покатаев И.А., Тюляндина А.С., Тюляндин С.А. Вопросы качества хирургического лечения при раке яичников. Злокачественные опухоли 2018;8(1):31–7. DOI: 10.18027/2224-5057-2018-8-1-31-37

8. Rumyantsev A.A., Pokataev I.A., Tyulyandina A.S., Tyulyandin S.A. Quality issues of surgical treatment for ovarian cancer. Zlokachestvennye opuholi = Malignant Tumors 2018;8(1):31–7. (In Russ.). DOI: 10.18027/2224-5057-2018-8-1-31-37

9. Fournier M., Huchon C., Ngo C. et al. Morbidity of rectosigmoid resection in cytoreductive surgery for ovarian cancer. Risk factoranalysis. Eur J Surg Oncol 2018;44(6):750–3. DOI: 10.1016/j.ejso.2018.01.005

10. Grimm C., Harter P., Alesina P.F. et al. The impact of type and number of bowel resections on anastomotic leakage risk in advancedovarian cancer surgery. Gynecol Oncol 2017;146(3): 498–503. DOI: 10.1016/j.ygyno.2017.06.007

11. Derlatka P., Sienko J., Grabowska-Derlatka L. et al. Results of optimaldebulking surgery with bowelresection in patients with advanced ovarian cancer. World J Surg Oncol 2016;14:58. DOI: 10.1186/s12957-016-0800-1

12. Кожевникова О.В., Князев Р.И., Ананьев В.С. и др. Результаты циторедуктивных операций у больных раком яичников с вовлечением различных отделов тонкой и толстой кишки. Онкогинекология 2023;4(48):12–22. DOI: 10.52313/22278710_2023_4_12

13. Kozhevnikova O.V., Knyazev R.I., Ananyev V.S. et al. The results of cytoreductive surgery in patients with ovarian cancer involving various parts of the small and large intestine. Onkogematologiya = Oncohematology 2023;4(48):12–22. (In Russ.). DOI: 10.52313/22278710_2023_4_12

14. Hertel H., Diebolder H., Herrmann J. et al. Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer. Gynecol Oncol 2001;83(3):481–4. DOI: 10.1006/gyno.2001.6338

15. Peiretti M., Bristow R.E., Zapardiel I. et al. Rectosigmoid resection at the time of primary cytoreduction for advancedovarian cancer. A multi-centeranalysis of surgical and oncological outcomes. Gynecol Oncol 2012;126(2):220–3. DOI: 10.1016/j.ygyno.2012.04.030