Can we identify the patients who are likely to undergo bowel resectionat the time of surgery for ovarian cancer?

Summary

Surgery for ovarian cancer carries a risk of bowel resection to either achieve optimal debulking or relieve obstruction. This prospective study assessed the likelihood of bowel resection in 842 women undergoing surgery for ovarian cancer and identified factors associated with increased risk. Bowel resection was performed in 8.6% of women. The likelihood of bowel resection increased significantly (p < 0.0001, χ² test) with:

1. Secondary surgery (22% vs 5.8% at primary surgery).

2. Symptoms of bowel disturbance (21.9% vs 6.3% if no symptoms).

3. FIGO stage III/IV disease (12.8% vs 2% in stage I/II).

4. CA125 levels ≥2500 (12.9% vs 4.8% if CA125<2500).

These women should be selectively offered pre-operative computerised tomography, stoma marking and counselling by stoma nurses. The 5-year survival was 14% in patients following bowel resection compared with 44% in patients not having bowel resection. Bowel resection should be performed only if it will result in optimal debulking or it relieves imminent bowel obstruction.