RESUMEN
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, chi2 test) with: Secondary surgery (22% vs 5.8% at primary surgery). Symptoms of bowel disturbance (21.9% vs 6.3% if no symptoms). FIGO stage III/IV disease (12.8% vs 2% in stage I/II). CA125 levels >or=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.
Asunto(s)
Intestinos/cirugía , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Antígeno Ca-125/sangre , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Intestinales/etiología , Enfermedades Intestinales/cirugía , Persona de Mediana Edad , Neoplasias Ováricas/mortalidad , Estudios Prospectivos , Factores de RiesgoRESUMEN
Residual disease following primary debulking surgery is a recognized prognostic factor in ovarian cancer. Few studies have looked at the effect of initial ovarian tumor diameter on survival. As larger tumors are more likely to be detected by ultrasound, this information may be important in determining a survival benefit in screen-detected cancers. We reviewed the case notes and pathology of 168 consecutive cases of primary debulking surgery in epithelial ovarian cancer. We examined the influence of ovarian tumor diameter on survival and its relationship to CA125 levels and stage. For the purposes of analyses, we divided subjects into two groups: those with tumors < 6 cm and those with tumors > 6 cm. There were significant differences between the groups, with smaller tumors having more advanced stage disease compared to larger tumors (chi23 = 15.7, P = 0.0013) The median survival for tumors less than or equal to 6 cm was 17months (95% confidence interval [95% CI], 12 to 22), while for tumors greater than 6cm, the median survival was 36 months (95% CI, 13 to 59; logrank test = 8.61, P = 0.003). However, stage is also an important predictor of survival, and in a multivariate analysis, tumor size was not found to be an independent prognostic factor. There was no significant difference between the groups for CA125 levels. As larger diameter ovaries are more likely to be detected by ultrasound, it may be that screen-detected ovarian cancers will show a survival benefit simply because they detect a subset of ovarian cancers that are associated with a better prognosis.