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Bowel Involvement in Advanced Ovarian Cancer Not a Predictor of Poor Outcome: Presented at SSO

By Mary Beth Nierengarten

CHICAGO -- March 18, 2008 -- Bowel involvement in patients with advanced epithelial ovarian cancer should not preclude a radical bowel resection at the time of tumour debulking to achieve optimal cytoreduction, according to research presented here at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium.

"Patients with [ovarian cancer and] bowel involvement who get optimal care have outcomes that are no different than for patients without bowel involvement," said lead author Saad Sirop, MD, Resident, McLaren Regional Medical Center, Flint, Michigan.

According to Dr. Sirop, the role of radical resection to achieve optimal cytoreduction in patients with stage III or IV ovarian cancer remains controversial. Although there is a shift toward including a bowel resection in these patients, there is still concern about the potential for increasing complications without additional benefit.

To assess the safety of radical bowel resection and its effect on recurrence and survival in patients with advanced ovarian cancer, Dr. Sirop and colleagues retrospectively reviewed the data of 92 consecutive patients with stage II to IV epithelial ovarian cancer treated between 1991 and 2006. The authors compared 2 groups of patients: those who had bowel resection at the time of primary debulking surgery (n = 48) (group A) and those who did not have bowel involvement and did not undergo a bowel resection (n = 44) (group B).

In group A, 5 patients (10%) had stage II disease, 38 (79%) had stage III disease, and 5 (10%) had stage IV disease. In group B, 6 patients (13%) had stage II, 30 (68%) had stage III disease, and 8 (18%) had stage IV disease. The 5 stage II patients in group A underwent bowel resection because of concomitant adhesions.

For both groups, the most common histological type of tumour was serous papillary carcinoma, identified in 48% of patients in group A and 91% in group B.

The types of bowel resection performed on the group A patients were as follows: large-bowel resection (67%), small-bowel resection (10%), gastrectomy (10%), and combined small- and large-bowel resection (12%).

In both groups, there was no difference in survival outcome (median overall survival, disease-free survival, and recurrence-free survival) between stage II, III, and IV disease. In addition, no difference was found between groups A and B in optimal cytoreduction rates (79% vs 82%, P = .79).

Overall, bowel continuity was maintained in 77% of the patients in group A; there was no perioperative mortality, and the most common morbidity was prolonged postoperative ileus.

In addition to evaluating the role of radical bowel resection in these patients, the study also examined the role of neoadjuvant chemotherapy as initial management for advanced disease in patients with bowel involvement at the time of diagnosis, which, according to Dr. Sirop, is an even more controversial issue.

The study found optimal cytoreduction in group A patients who underwent neoadjuvant chemotherapy followed by surgery versus those who underwent primary surgery with bowel resection without neoadjuvant chemotherapy (85% vs 62%, P = .08). Survival rates, however, were similar (27 vs 25 months, respectively).

According to Dr. Sirop, patients with bulkier disease were selected for neoadjuvant chemotherapy, and this selection bias may be a contributing factor to the lack of survival difference.

Dr. Sirop recommended consideration of neoadjuvant chemotherapy at the time of diagnosis in patients with bowel involvement.

Based on these study results, Dr. Sirop concluded that "bowel involvement is not in itself a poor prognostic factor."


[Presentation title: The Impact of Radical Bowel Resection During Primary Surgery on the Recurrence and Survival in Epithelial Ovarian Cancer. Abstract P219]

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