Research Article| Volume 126, ISSUE 2, P220-223, August 2012

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Rectosigmoid resection at the time of primary cytoreduction for advanced ovarian cancer. A multi-center analysis of surgical and oncological outcomes



      The aim of the study was to determine the impact of rectosigmoid resection, at the time of primary cytoreductive surgery, on morbidity and survival of patients with advanced ovarian cancer.


      We performed a retrospective medical chart review of patients who underwent rectosigmoid resection for ovarian, tubal and peritoneal cancers between 1998 and 2008 at the IEO in Milan and JHMI in Baltimore. Perioperative and follow-up data were collected.


      A total of 238 patients were identified; 180 (75%) had stages IIC–IIIC and 58 (25%) had stage IV. Complete cytoreduction was achieved in 41% of the cases. Stapled coloproctostomy was performed in 98% while hand sewn in only 2%; a protective ileostomy and colostomy were necessary (constructed) in 2 (0.8%) and 5 (2%) cases respectively. The complications associated to rectosigmoid resection were anastomotic leakage in 7 (3%) patients and pelvic abscess in 9 (3.7%). Fifty percent of patients recurred during the study period, but only 5% of them showed a relapse at the level of the pelvis whereas 8% presented with abdominal recurrence associated with pelvic disease as well. The median overall survival time among patients with complete cytoreduction was 72 months compared with 42 months among the rest of patients (p=0.002).


      Rectosigmoid colectomy may significantly contribute to achieve a complete primary cytoreduction for advanced stage ovarian, tubal and peritoneal cancers. Pelvic complete debulking accomplished by rectosigmoid resection could be associated with a lower rate of pelvic recurrence as well.


      • Rectosigmoid colectomy can contribute significantly to a maximal cytoreductive surgical effort for recurrent ovarian cancer.
      • Pelvic complete debulking accomplished by rectosigmoid resection seems to be associated with a significant lower rate of pelvic recurrence.


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        • National Cancer Institute [home page on the internet]
        (Available from:)
        • Chi D.S.
        • Eisenhauer E.L.
        • Lang J.
        • Huh J.
        • Haddad L.
        • Abu-Rustum N.R.
        • et al.
        What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?.
        Gynecol Oncol. 2006; 103: 559-564
        • Shih K.K.
        • Chi D.S.
        Maximal cytoreductive effort in epithelial ovarian cancer surgery.
        J Gynecol Oncol. 2010; 21: 75-80
        • Zapardiel I.
        • Morrow C.P.
        New terminology for cytoreduction in advanced ovarian cancer.
        Lancet Oncol. 2011; 12: 214
        • Peiretti M.
        • Zanagnolo V.
        • Aletti G.D.
        • Bocciolone L.
        • Colombo N.
        • Landoni F.
        • et al.
        Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: surgical and oncological outcomes. Single institution experience.
        Gynecol Oncol. Nov 2010; 119: 259-264
        • Eisenkop S.M.
        • Spirtos N.M.
        Procedures required to accomplish complete cytoreduction of ovarian cancer: is there a correlation with “biological aggressiveness” and survival?.
        Gynecol Oncol. 2001; 82: 435-441
        • Barber H.R.K.
        • Brunschwig A.
        Pelvic exenteration for locally advanced and recurrent ovarian cancer.
        Surgery. 1965; 58: 935-937
        • Hudson C.N.
        A radical operation for fixed ovarian tumors.
        J Obstet Gynaecol Br Commonw. 1968; 75: 1155-1160
        • Hudson C.N.
        • Chir M.
        Surgical treatment of ovarian cancer.
        Gynecol Oncol. 1973; 1: 370-378
        • Clayton R.D.
        • Obemair A.
        • Hammond I.G.
        • Leung Y.C.
        • McCartney A.J.
        The western Australian experience of the use of en bloc resection of ovarian cancer with concomitant rectosigmoid colectomy.
        Gynecol Oncol. 2002; 84: 53-57
        • Berek J.S.
        • Hacker N.F.
        • Lagasse L.D.
        Rectosigmoid colectomy and reanastomosis to facilitate resection of primary and recurrent gynecologic cancer.
        Obstet Gynecol. 1984; 64: 715-720
        • Soper J.T.
        • Couchman G.
        • Berchuk A.
        • Clarke-Pearson D.
        The role of partial sigmoid colectomy for debulking epithelial ovarian carcinoma.
        Gynecol Oncol. 1991; 41: 239-244
        • Obermair A.
        • Hagenauer S.
        • Tamandl D.
        • Clayton R.D.
        • Nicklin J.L.
        • Perrin L.C.
        • et al.
        Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer.
        Gynecol Oncol. 2001; 83: 115-120
        • Sainz de la Cuesta R.
        • Goodman A.
        • Halverson S.S.
        • Fuller A.F.
        En bloc pelvic peritoneal resection of the intraperitoneal pelvic viscera in patients with advanced epithelial ovarian cancer.
        Cancer J Sci Am. 1996; 2: 152-157
        • Hacker N.F.
        • Berek J.S.
        • Lagasse L.D.
        • Nieberg R.K.
        • Elashoff R.M.
        Primary cytoreductive surgery for epithelial ovarian cancer.
        Obstet Gynecol. 1983; 61: 413-420
        • Hoskins W.J.
        Epithelial ovarian carcinoma: principles of primary surgery.
        Gynecol Oncol. 1994; 55: S91-S96
        • Cheung H.Y.
        • Chung C.C.
        • Tsang W.W.
        • Wong J.C.
        • Yau K.K.
        • Li M.K.
        Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial.
        Arch Surg. 2009; 144: 1127-1132
        • Bristow R.E.
        • Puri I.
        • Chi D.S.
        Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis.
        Gynecol Oncol. 2009; 112: 265-274
        • Richardson D.L.
        • Mariani A.
        • Cliby W.A.
        Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer.
        Gynecol Oncol. 2006; 103: 667-672
        • Mourton S.M.
        • Temple L.K.
        • Abu-Rustum N.R.
        • Gemignani M.L.
        • Sonoda Y.
        • Bochner B.H.
        • et al.
        Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer.
        Gynecol Oncol. 2005; 99: 608-614
        • Cai H.B.
        • Zhou Y.F.
        • Chen H.Z.
        • Hou H.Y.
        The role of bowel surgery with cytoreduction for epithelial ovarian cancer.
        Clin Oncol. 2007; 19: 757-762
        • Spirtos N.M.
        • Eisenkop S.M.
        • Schlaerthm J.B.
        • Ballon S.C.
        Second-look laparotomy after modified posterior exenteration: patterns of persistence and recurrence in patients with stage III and stage IV ovarian cancer.
        Am J Obstet Gynecol. 2000; 182: 1321-1327
        • Hertel H.
        • Diebolder H.
        • Herrmann J.
        • Köhler C.
        • Kühne-Heid R.
        • Possover M.
        • et al.
        Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer.
        Gynecol Oncol. 2001; 83: 481-484
        • Aletti G.D.
        • Podratz K.C.
        • Jones M.B.
        • Cliby W.A.
        Role of rectosigmoidectomy and stripping of pelvic peritoneum in outcomes of patients with advanced ovarian cancer.
        J Am Coll Surg. 2006; 203: 521-526
        • Salani R.
        • Zahurak M.L.
        • Santillan A.
        • Giuntoli R.L.
        • Bristow R.E.
        Survival impact of multiple bowel resections in patients undergoing primary cytoreductive surgery for advanced ovarian cancer: a case–control study.
        Gynecol Oncol. 2007; 107: 495-499