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Clinical characteristics and outcomes after bowel surgery and ostomy formation at the time of debulking surgery for advanced-stage epithelial ovarian carcinoma
  1. Allison Ann Gockley1,
  2. Stephen Fiascone1,
  3. Katherine Hicks Courant2,
  4. Kristen Pepin3,
  5. Marcela Del Carmen4,
  6. Rachel M Clark4,
  7. Joel Goldberg5,
  8. Neil Horowitz6,
  9. Ross Berkowitz6 and
  10. Michael Worley Jr6
  1. 1 Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts Medical School, Boston, Massachusetts, USA
  3. 3 Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
  5. 5 Divsion of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Allison Ann Gockley, Brigham and Women's Hospital, Boston, MA 02115, USA; agockley{at}partners.org

Abstract

Objective There are limited data on clinical outcomes of patients with advanced-stage epithelial ovarian cancer who require ostomy formation at the time of either primary cytoreductive surgery or interval cytoreductive surgery. The objective of this study was to evaluate patients undergoing bowel surgery and ostomy formation after primary or interval surgery.

Methods Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV epithelial ovarian cancer who underwent cytoreductive surgery between January 2010 and December 2014 were identified retrospectively. Patients with non-epithelial histology, low-grade serous histology or incomplete medical records were excluded. Demographic and clinical data were collected and analyzed. Age, stage, co-morbidity index, pre-operative CA125, pre-operative albumin, and Aletti surgical complexity score were included in a multivariable logistic regression model to assess independent associations with ostomy formation.

Results A total of 554 patients were included in the study. Of these, 261 (47%) underwent primary cytoreduction and 293 (53%) underwent interval cytoreduction. Patients undergoing primary surgery were more likely to undergo bowel resection, compared with interval surgery patients (37.2% vs 14%, p<0.001). Of the 139 (25.1%) patients who underwent bowel surgery, 25 (18%) underwent ostomy formation (11 ileostomies and 14 colostomies). Rates of ostomy formation were similar between the groups (6.1% primary vs 3.1% interval, p=0.10). Patients undergoing ostomy formation were more likely to have longer mean operative time (335 vs 229 min, p<0.001) and undergo small and large bowel resections at the time of cytoreductive surgery (44% vs 14%, p<0.001). Multivariate analysis revealed that a high surgical complexity score was associated with ostomy formation. Of the patients who underwent ostomy formation, 13 (43.3%) underwent stoma reversal including 11 ileostomies and two colostomies. Median time to ostomy reversal was 7 months.

Conclusion Bowel surgery is more common among patients undergoing primary surgery as compared with interval surgery, but this does not result in an increased risk of ostomy formation.

  • bowel surgery
  • cytoreductive surgery
  • ostomy
  • ovarian cancer
  • ostomy reversal
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Footnotes

  • Contributors All authors contributed to the conception, editing and formation of the manuscript. AAG and MW co-led this project. Data collection was completed by AAG, SF and KP. Data analysis was completed by KHC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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