The role of bowel resection in the primary surgical debulking of carcinoma of the ovary.

BACKGROUND

Extensive debulking is accepted for the primary operative management of advanced epithelial carcinoma of the ovary. However, there is no consensus regarding the role of bowel resection with concern that morbidity may be increased without increasing survival or quality of life.

STUDY DESIGN

The study was a retrospective review of 34 women who underwent bowel resection as a part of primary surgical debulking for advanced epithelial carcinoma of the ovary from 1982 to 1992.

RESULTS

Twenty-two patients (65 percent) had optimal debulking with postoperative residual tumor of less than 2 cm in diameter. Primary reanastomosis was possible in 28 (82 percent) of the patients, with the remaining six (18 percent) requiring ileostomy or colostomy. There were no postoperative deaths. Extensive postoperative morbidity occurred in eight patients (24 percent). All patients received postoperative chemotherapy with a platinum-containing combination. Survival of the group with optimal debulking was significantly better compared with the group in which debulking was less than optimal. The overall outcome in terms of postoperative morbidity and survival rates was similar when compared with a group of patients who underwent primary surgical debulking of advanced carcinoma of the ovary.

CONCLUSIONS

It is recommended that aggressive efforts at complete cytoreduction be undertaken, including bowel resection, to reduce tumor burden. This approach will afford the patient with advanced carcinoma of the ovary an improved chance for survival, with no increase in perioperative morbidity, when optimal debulking is accomplished.