Survival impact of bowel resection at the time of interval cytoreductive surgery for advanced ovarian cancer

• Main Authors: Blair McNamara (Author), Rosa Guerra (Author), Jennifer Qin (Author), Amaranta D. Craig (Author), Lee-may Chen (Author), Madhulika G. Varma (Author), Jocelyn S. Chapman (Author)
• Format: Book
• Published: Elsevier, 2021-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2352-5789; 10.1016/j.gore.2021.100870
• Keywords: Bowel resection; Ovarian cancer; Neoadjuvant chemotherapy; Interval cytoreduction; Gynecology and obstetrics; RG1-991; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; RC254-282
• Source: Gynecologic Oncology Reports, Vol 38, Iss , Pp 100870- (2021)

Objectives: To evaluate the impact of bowel resection at the time of interval cytoreductive surgery on survival. Methods: We identified patients with advanced ovarian cancer who underwent neoadjuvant chemotherapy and interval cytoreductive surgery between 2008 and 2018 from a single-institution tumor registry. Kaplan-Meier survival analysis and Cox proportional hazards models were performed comparing patients who underwent bowel resection to those who did not. Results: Of 158 patients, 43 (27%) underwent bowel resection. Rates of optimal (95%) and sub-optimal (5%) resection did not differ with bowel resection. Patients that required bowel resection had worse three-year survival (43% vs. 63%), even after adjusting for confounding variables of age, stage, number of neoadjuvant cycles, R0 resection, and ASA score (HR 2.27, p < 0.01). Adjusted progression-free survival did not differ between groups (HR 0.92, p = 0.72). Patients who underwent bowel resection were more likely to require blood transfusion (p < 0.01), and have a longer hospital stay (5 days vs 7.5 days, p < 0.01). Conclusions: Bowel resection at the time of interval cytoreduction confers a greater than 2-fold increased risk of mortality and does not impact progression-free survival. Long-term sequelae of the peri-operative morbidity of bowel resection may contribute to increased mortality, and bowel resection may be a surrogate for disease biology with poor prognosis.