Postoperative Intestinal Fistula in Primary Advanced Ovarian Cancer Surgery

Antoni Llueca

Anna Serra

Maria Climent

Karina Maiocchi

Alvaro Villarin

Katty Delgado

Josep Mari-Alexandre

Juan Gilabert-Estelles

Paula Carrasco+6 authors

^{Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain}

^{Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain}

^{Department of Medicine, University Jaume I (UJI), Castellon, Spain}

^{Department of General Surgery, University General Hospital of Castellon, Castellón, Spain}

^{Department of Radiology, University General Hospital of Castellon, Castellón, Spain}

^{Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain}

^{Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain}

^{University of Texas MD Anderson Cancer Center, Gynecology Oncology, Houston, Texas, USA}

Correspondence: Antoni Llueca Email antonillueca@gmail.com

Received 2020 Sep 5; Accepted 2020 Nov 27.

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Abstract

Background

Advanced ovarian cancer (AOC) requires an aggressive surgery with large visceral resections in order to achieve an optimal or complete cytoreduction and increase the patient’s survival. However, the surgical aggressiveness in the treatment of AOC is not exempt from major complications, such as the gastrointestinal fistula (GIF), which stands out among others due to its high morbidity and mortality.

Methods

We evaluated the clinicopathological features in patients with AOC and their association with GI. Data for 107 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. Clinicopathological features, including demographic, surgical procedures and follow-up data, were analyzed in relation to GIF.

Results

GIF was present in 11% of patients in the study, 5 (4.5%) and 7 (6.4%) of colorectal and small bowel origin, respectively. GIF was significantly associated with peritoneal cancer index (PCI) >20, more than 2 visceral resections, and multiple digestive resections. Overall and disease-free survival were also associated with GIF. Multivariate analysis identified partial bowel obstruction and operative bleeding as independent prognostic factors for survival. The presence of GIF is positively associated with poor prognosis in patients with AOC.

Conclusion

Given the importance of successful cytoreductive surgery in AOC, the assessment of the amount of tumor and the aggressiveness of the surgery to avoid the occurrence of GIF become a priority in patients with AOC.

Keywords: advanced ovarian cancer surgery, complications, intestinal leakage, intestinal fistula

Abstract

Acknowledgments

We thank Begoña Belles, PhD, for editing a draft of this manuscript.

MUAPOS working group (Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery):

Gomez-Quiles L., Játiva R., Cebrian G., Bosso, V., Villarin, A., Maiocchi, K., Delgado-Barriga K., Rodrigo-Aliaga M., Ruiz N., Herrero C., Frances, A., Beato I, Ferrer C., Aracil JP, Boldo E, Boldo A, Adell R.

Acknowledgments

Funding Statement

This work received financial support from de Medtronic University Chair for Training and Surgical Research, University Jaume I (UJI), Castellón, Spain and also supported by a research grant from ISCIII-FEDER (PI17/01945).

Funding Statement

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