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Laparoscopic sigmoidectomy with ghost ileostomy in ovarian cancer recurrence
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  1. Pablo Padilla-Iserte1,
  2. Manel Montesinos-Albert2,
  3. Marta Arnaez3,
  4. Victor Lago4,
  5. Matteo Frasson5,
  6. Luis Matute6 and
  7. Santiago Domingo7
  1. 1 Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
  2. 2 Department of Obstetrics and Gynecology, University Hospital La Fe, Valencia, Spain
  3. 3 Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
  4. 4 Department of Gynecologic Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain, Valencia, Spain
  5. 5 Colorectal Unit, Polytechnic Hospital, Valencia, Spain
  6. 6 Hospital Universitari i Politècnic La Fe, Valencia, Valenciana, Spain
  7. 7 Department of Gynecology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
  1. Correspondence to Dr Manel Montesinos-Albert, Department of Obstetrics and Gynecology, University Hospital La Fe, Valencia, Spain; manelmontesinosalbert{at}gmail.com

https://doi.org/10.1136/ijgc-2023-004853

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    In relapsed ovarian cancer, systemic treatment has been the standard of care. However, recent studies, such as the Desktop III study, have indicated that cytoreductive surgery followed by chemotherapy can lead to longer overall survival compared with chemotherapy alone.1 These findings may result in more patients choosing surgery as a treatment option for relapse. In cases of local relapse of advanced epithelial ovarian cancer, surgical treatment often involves sigmoid resection, with the possibility of primary reanastomosis.2

    This case involves a woman diagnosed in 2018 with high-grade serous adenocarcinoma, characterized by positive peritoneal washing cytology. She underwent a complete staging surgery for early-stage ovarian cancer, which included laparoscopic sigmoidectomy with a ghost ileostomy.3 The final International Federation of Gynecology and Obstetrics (FIGO) stage was identified as high-grade serous carcinoma FIGO IC3. After undergoing surgical treatment, the patient underwent four cycles of adjuvant chemotherapy. However, during a follow-up scan, 4 years later, a 4 cm tumor was detected in the mid-superior rectum, confirming the presence of a local relapse. Consequently, it was decided to proceed with secondary cytoreductive surgery to address the relapse of ovarian cancer.

    This case highlights the potential benefits of using a laparoscopic approach to achieve satisfactory oncologic outcomes while minimizing the post-operative risks and delays in adjuvant treatments. Performing surgical intervention during the relapse of advanced ovarian cancer has been proved to significantly enhance oncologic outcomes, particularly by prolonging progression-free survival and overall survival rates. It is worth highlighting that surgical intervention does not adversely impact the quality of life of patients, ensuring that their overall well-being is not compromised. The positive impact of surgery for improved oncologic outcomes and the maintenance of a satisfactory quality of life makes it a valuable and beneficial option for individuals experiencing relapse in advanced ovarian cancer. In addition, minimally invasive surgery is equally effective as laparotomy in ensuring disease-free survival for women diagnosed with advanced-stage epithelial ovarian cancer who have positively responded to neoadjuvant chemotherapy.4 5 This case presentation was carried out with informed consent and ensuring preservation of the patient’s anonymity.

    Figure 1
    Figure 1

    Intra-operative appearance following colorectal anastomosis.

    Video 1 Laparoscopic view of the colorectal anastomosis following rectosigmoid resection.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    References

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      4. Vergote I , et al
      . Randomized trial of cytoreductive surgery for relapsed ovarian cancer. N Engl J Med 2021;385:2123–31. doi:10.1056/NEJMoa2103294
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      . Ghost ileostomy: prevention, diagnosis, and early treatment of colorectal anastomosis leakage in advanced ovarian cancer. Int J Gynecol Cancer 2022;32:109–10. doi:10.1136/ijgc-2021-003060
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      2. Nitecki R ,
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      2. Conte C ,
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      4. Loverro M , et al
      . Role of minimally invasive secondary cytoreduction in patients with recurrent ovarian cancer. Int J Gynecol Cancer 2023;33:137–44. doi:10.1136/ijgc-2022-003904
      OpenUrlAbstract/FREE Full Text

    Footnotes

    • Twitter @MMontesinos_Alb

    • Contributors PP-I: Conceptualization, project administration, surgery, video recording, supervision, writing – review.

      MM-A: Guarantor, conceptualization, video editing, writing - original draft.

      MA: Conceptualization, project administration, supervision, surgery, and writing – review.

      VL: Conceptualization, project administration, supervision, writing – review.

      MF: Conceptualization, project administration, surgery, supervision, writing – review.

      LM: Conceptualization, project administration, surgery, supervision, writing – review.

      SD: Conceptualization, project administration, supervision, writing – review.

    • 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.

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