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Impact of Extended Primary Surgery on Suboptimally Operable Patients With Advanced Ovarian Cancer
  1. Anton Oseledchyk, MD,
  2. Lena Elisa Hunold,
  3. Michael R. Mallmann, MD,
  4. Christian M. Domröse, MD,
  5. Alina Abramian, MD,
  6. Manuel Debald, MD,
  7. Christina Kaiser, MD,
  8. Nicholas Kiefer, PhD,
  9. Christian Putensen, PhD,
  10. Dimitrios Pantelis, PhD,
  11. Rolf Fimmers, PhD,
  12. Walther Kuhn, PhD,
  13. Nico Schäfer, PhD and
  14. Mignon-Denise Keyver-Paik, MD
  1. * Departments of Obstetrics and Gynecology,
  2. Anesthesiology and Intensive Care Medicine, and
  3. Surgery, Center for Integrated Oncology; and
  4. § Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
  1. Address correspondence and reprint requests to Anton Oseledchyk, MD, Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. E-mail: anton.oseledchyk{at}ukb.uni-bonn.de.

Abstract

Objectives Extensive surgical efforts to achieve an optimal debulking (no residual tumor) in primary surgery of ovarian cancer are today’s criterion standard in gyneco-oncologic surgery. However, it is controversial whether extensive surgery, including resections of metastases in the upper abdomen and bowel resections, is justifiable in patients with not completely operable lesions.

Methods All patients who had undergone surgery for ovarian cancer in the years 2002 to 2013 at our institution were viewed (n = 472). We retrospectively identified 278 operations for primary ovarian cancer. Ninety-six (35%) of the 278 patients showed postoperative tumor residuals and were included in this study.

Results Fifty-five (57%) of 96 patients underwent bowel resection, showing significantly higher complication rates (64% vs 39% minor complications, P = 0.017; 31% vs 9.8% severe complications, P = 0.013) compared with patients without bowel resections as well as no improvement in progression-free or overall survival (median overall survival, 19.5 vs 32.9; P = 0.382). Multiple anastomoses (≥2) were associated with higher rates for anastomotic leakage (16.7% vs 2.6%, P = 0.02) and a higher mortality (16.7% vs 0%, P = 0.04) compared with patients with only 1 anastomosis. Extensive surgery of the upper abdomen was not associated with a significant increase in complication rates.

Conclusions Because of the increased morbidity of bowel resections without any evidence for improvement of survival, we suggest to restrain from further resection of intestines if an optimal debulking seems not feasible after removal of the major tumor bulk.

  • Anastomosis
  • Bowel resection
  • Postoperative complications
  • Primary ovarian cancer

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Footnotes

  • The authors declare no conflicts of interest.

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