The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery

• Published in: Gynecologic oncology Vol. 146; no. 3; pp. 498 - 503
• Main Authors: Grimm, Christoph, Harter, Philipp, Alesina, Pier F, Prader, Sonia, Schneider, Stephanie, Ataseven, Beyhan, Meier, Beate, Brunkhorst, Violetta, Hinrichs, Jakob, Kurzeder, Christian, Heitz, Florian, Kahl, Annett, Traut, Alexander, Groeben, Harald T, Walz, Martin, du Bois, Andreas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Aged; Anastomosis, Surgical - adverse effects; Anastomotic Leak - etiology; Anastomotic leakage; Bowel resection; Carcinoma, Ovarian Epithelial; Colectomy - adverse effects; Colon, Sigmoid - surgery; Cytoreduction Surgical Procedures - adverse effects; Debulking surgery; Epithelial ovarian cancer; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasms, Glandular and Epithelial - surgery; Obstetrics and Gynecology; Ovarian Neoplasms - surgery; Prognosis; Rectum - surgery; Retrospective Studies; Risk Factors; Survival Rate; Bowel resection; Anastomotic leakage; Epithelial ovarian cancer; Debulking surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2017.06.007

Abstract Objective To identify risk factors for anastomotic leakage (AL) in patients undergoing primary advanced ovarian cancer surgery and to evaluate the prognostic implication of AL on overall survival in these patients. Methods We analyzed our institutional database for primary EOC and included all consecutive patients treated by debulking surgery including any type of full circumferential bowel resection beyond appendectomy between 1999 and 2015. We performed logistic regression models to identify risk factors for AL and log-rank tests and Cox proportional hazards models to evaluate the association between AL and survival. Results AL occurred in 36/800 (4.5%; 95% confidence interval [3%–6%]) of all patients with advanced ovarian cancer and 36/518 (6.9% [5%–9%]) patients undergoing bowel resection during debulking surgery. One hundred fifty-six (30.1%) patients had multiple bowel resections. In these patients, AL rate per patient was only slightly higher (9.0% [5%–13%]) than in patients with rectosigmoid resection only (6.9% [4%–10%]), despite the higher number of anastomosis. No independent predictive factors for AL were identified. AL was independently associated with shortened overall survival (HR 1.9 [1.2–3.4], p = 0.01). Conclusion In the present study, no predictive pre- and/or intraoperative risk factors for AL were identified. AL rate was mainly influenced by rectosigmoid resection and only marginally increased by additional bowel resections.