Abstract: Objective: To identify a reasonable surgical strategy and to discuss the benefits and morbidity of and indications for colorectal resections in ovarian carcinomatosis. Methods: From a series of 70 patients treated with peritonectomy and HIPEC for diffuse ovarian carcinomatosis 52 patients had colorectal resections. We considered techniques for colorectal resection, histopathological features of resected specimens, postoperative risk factors and prognostic variables in univariate and multivariate analyses. Literature regarding cytoreductive surgery with colon resection was then reviewed. Results: Peritonectomy procedures included as well as colorectal resection various other visceral resection (mean 7.5 per patient). Optimal cytoreduction rate was 86% (CC0 and CC1). A total 13.4% of patients had Grade IV complications requiring reoperation or intensive care. Multivariate analysis identified as the main risk factor for postoperative complications a blood loss of ≥ 2000 ml. In all 52 patients ovarian implants deeply infiltrated the colorectal wall usually (67.3%) up to the muscular layer. Lymph-node metastases, detected in 50% of the cases, involved colorectal regional nodes in 42.3%. The 5-year survival rate was 44.4% and 5-year disease-free survival was 32.6%. Cox regression identified as the main prognostic factors, depth of colorectal wall invasion and degree of cytoreduction. Some of the literature regarding colon resection is conflicting and all data are retrospective, however, most of papers supports a benefit in terms of survival when cytoreduction is clearly optimal. Conclusions: In patients with ovarian diffuse peritoneal carcinomatosis colorectal resections are essential in achieving maximal cytoreduction. Colorectal resections in ovarian carcinomatosis should follow the oncologic rules for primary colorectal cancer. The literature review suggests that colon resection to achieve optimal cytoreduction has a positive impact on survival.
Colorectal Resection during Peritonectomy plus HIPEC in Patients with Diffuse Ovarian Carcinomatosis: our experience and a review of the literature / Luciani, Claudio; AMORE BONAPASTA, Stefano; Cardi, Maurizio; DI GIORGIO, Angelo. - (2011). (Intervento presentato al convegno EUROPEAN COLORECTAL CONGRESS tenutosi a St.Gallen, Switzerland nel 29th November 2011 - 2nd December 2011).
Colorectal Resection during Peritonectomy plus HIPEC in Patients with Diffuse Ovarian Carcinomatosis: our experience and a review of the literature.
LUCIANI, CLAUDIO;AMORE BONAPASTA, Stefano;CARDI, Maurizio;DI GIORGIO, Angelo
2011
Abstract
Abstract: Objective: To identify a reasonable surgical strategy and to discuss the benefits and morbidity of and indications for colorectal resections in ovarian carcinomatosis. Methods: From a series of 70 patients treated with peritonectomy and HIPEC for diffuse ovarian carcinomatosis 52 patients had colorectal resections. We considered techniques for colorectal resection, histopathological features of resected specimens, postoperative risk factors and prognostic variables in univariate and multivariate analyses. Literature regarding cytoreductive surgery with colon resection was then reviewed. Results: Peritonectomy procedures included as well as colorectal resection various other visceral resection (mean 7.5 per patient). Optimal cytoreduction rate was 86% (CC0 and CC1). A total 13.4% of patients had Grade IV complications requiring reoperation or intensive care. Multivariate analysis identified as the main risk factor for postoperative complications a blood loss of ≥ 2000 ml. In all 52 patients ovarian implants deeply infiltrated the colorectal wall usually (67.3%) up to the muscular layer. Lymph-node metastases, detected in 50% of the cases, involved colorectal regional nodes in 42.3%. The 5-year survival rate was 44.4% and 5-year disease-free survival was 32.6%. Cox regression identified as the main prognostic factors, depth of colorectal wall invasion and degree of cytoreduction. Some of the literature regarding colon resection is conflicting and all data are retrospective, however, most of papers supports a benefit in terms of survival when cytoreduction is clearly optimal. Conclusions: In patients with ovarian diffuse peritoneal carcinomatosis colorectal resections are essential in achieving maximal cytoreduction. Colorectal resections in ovarian carcinomatosis should follow the oncologic rules for primary colorectal cancer. The literature review suggests that colon resection to achieve optimal cytoreduction has a positive impact on survival.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
