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Rectosigmoidectomy and Douglas Peritonectomy in the Management of Serosal Implants in Advanced-Stage Ovarian Cancer Surgery: Survival and Surgical Outcomes
  1. Selçuk Erkilinç, MD*,
  2. Volkan Karataşli, MD*,
  3. Batuhan Demir, MD,
  4. İlker çakir, MD*,
  5. Behzat Can, MD*,
  6. Tuğba Karadeniz, MD,
  7. Mehmet Gökçü, MD* and
  8. Muzaffer Sanci, MD*
  1. *Department of Gynecological Oncology, Tepecik Education and Research Hospital, University of Health Sciences, Yenişehir, Konak, Izmir, Turkey.
  2. Department of General Surgery, Tepecik Education and Research Hospital, University of Health Sciences, Yenişehir, Konak, Izmir, Turkey.
  3. Department of Pathology, Tepecik Education and Research Hospital, University of Health Sciences, Yenişehir, Konak, Izmir, Turkey.
  1. Address correspondence and reprint requests to Selçuk Erkilinç, MD, Gaziler Caddesi, No. 75, Yenişehir Konak, Izmir 35200 Turkey. E-mail: selcukerkilinc{at}


Objective This study aimed to evaluate the outcomes of rectosigmoid resection (RR) and Douglas peritonectomy (DP) on postoperative complications and survival in advanced-stage ovarian cancer surgery.

Methods/Materials Patients who underwent optimal cytoreductive surgery including RR and DP between January 2007 and January 2013 were included. Patients with deeper invasion into the muscularis and mucosal layer reported in pathology results and colon wall injury necessitating suturing or resection suggesting invasion of implants into the colon wall were excluded. The decision for RR or DP was made according to the surgical team and patients’ preference. Resections were performed with the suspicion of colon wall invasion. The collected data were age, previous operations, preoperative cancer antigen 125 and albumin levels, surgical procedures, duration of surgery, tumor histology, recurrence, hyperthermic intraperitoneal chemotherapy, and length of hospital stay. Kaplan-Meir survival estimates were calculated and compared between the groups using the log-rank test. Cox proportional models were built to evaluate factors that affected disease-free and overall survival.

Results Age, body mass index, preoperative cancer antigen 125 levels, albumin levels, and amount of ascites were similar between the groups. Neoadjuvant chemotherapy followed by interval debulking surgery was performed in 15% of both groups. End colostomy was performed in 23.7% of the RR group, and only 5.08% of the patients underwent diverting ileostomy procedures. There was no significant difference in terms of surgical complications between the groups. Recurrence occurred in the RR and DP groups at rates of 42% and 47%, respectively. Only primary debulking surgery had an effect on overall survival (odds ratio, 0.5; 95% confidence interval, 0.31–0.88). Overall survival and disease-free survival were similar in the RR and DP groups.

Conclusions Douglas peritonectomy showed similar survival and surgical outcomes to RR and provided shorter hospital stay and earlier admission to chemotherapy in the management of serosal implants during advanced-stage ovarian cancer surgery.

  • Rectosigmoid resection
  • Douglas peritonectomy
  • Surgical outcomes
  • Survival
  • Ovarian cancer

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  • Financial disclosure: None.

  • The authors did not receive for this work from any of the following organizations: National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, and others.

  • The authors declare no conflict of interest.