BENEFIT OF RADICAL RESECTION OF BOWL INVOLMENT IN ADVANCE OVARIAN CARTINA

Dr. Saha has a special interest in neoadjuvant treatment for ovarian and cervical carcinomas.  He has presented numerous articles regarding these subjects. 

Ovarian carcinoma most frequently presents in the late stages of disease (stage III and IV) with an overall survival of less than 50%.  More than 40% of these patients have bowel involvement at the time of initial or subsequent operation.  This is considered to have an adverse affect on survival.  This study looks at (1) the effect bowel involvement has on patient survival and (2) the role of radical debulking on overall prognosis.

The study was a retrospective review of 57 patients undergoing laparotomy with a final histopathological diagnosis of ovarian carcinoma between the years 1992-1997.  Mean follow up was 24 months.

54.4% (31/57) patients had clinical bowel involvement with tumor.  23 patients had colorectal invasion; 3 of the smallbowel.  4 of the colon and small bowel, and 1 of the stomach.  20 of these were diagnosed in the initial exploration.  61.3% (19/31) were considered optimal debulking procedures with complete resection of all involved bowel segments.  Preservation of bowel continuity was achievable in 67.7% (21/31) of cases primarily and 81% (25/31) overall (colostomy closure).  There were no postoperative deaths.  Of the 31 patients undergoing bowel resection with tumor debulking.  61.3% (19/31) are alive to date.  However, of those patients who had optimal debulking procedures, which include portions of bowel.  78.9% (15/19) are alive as compare to 33.3% (4/12) of those who had suboptimal resections.  Of those patients without clinical bowel involvement (n=26).  68% (17/25) are alive to date.  One patient without bowel involvement died of unrelated reasons six months after initial laparotomy.

Overall, some form of bowel was involved in 54.4% of patients but the prognosis was not significantly affected by this intraoperative finding (61.3% vs. 68%).  However, the prognosis was significantly worse if a suboptimal resection was performed; however, if an optimal resection was achievable, the survival rate was significantly improved (33.3% vs. 78.9%).  This data emphasizes the importance of aggressive debunking for advanced stage ovarian carcinoma despite the frequent occurrence of bowel involvement.