Evaluation of urgent multivisceral resections due to complications resulting from an advanced ovarian cancer

Abstract

Background: Unlike other solid tumors (i.e. pancreas, gallbladder, stomach), an ovarian cancer is responsive to a systemic treatment with platinum derivates in 80% of patients. This apparent chemosensitivity justifies a broader surgical approach. A cytoreductive, ”tumor-debulking” surgery is defined as an attempt to remove in a maximum degree all visible and detect­able lesions. Despite treatment, the advancement of the disease very often leads to complications defined as “surgical” and life-threatening.

Objectives: The aim was to evaluate the efficacy and safety of palliative surgery in advanced ovarian cancer implicating acute surgical diseases of the abdominal cavity.

Material and methods: Between years 2005 and 2014 were operated 118 patients with an advanced ovarian cancer (FIGO III-IV) implicating acute and directly life-threatening diseases of the abdominal cavity, involving 132 surgical operations. The causes of these operations were: obstruction of the gastrointestinal tract — 91 patients; perforation of the gastrointestinal tract — 15; gastrointestinal bleeding — 9; intussusceptions — 3.

Results: Retrospective data for the 118 patients were analyzed. Safety and the perioperative mortality rate were assessed. Serious postoperative complications were recorded in 31 patients (anastomotic stoma — 9; bleeding requiring repeated surgery —3; recurring gastrointestinal obstruction — 16; liver failure after partial hepatic resection — 3). Systemic compli­cations in the form of respiratory failure and cardiovascular disorders requiring cardiological treatment — 21. All patients required clinical nutrition, both parenteral and enteral. Deaths recorded — 3. 39 patients were rehospitalized within 30 days of surgery. 7 deaths were recorded in this group.

Conclusions: Combining lifesaving surgery with cytoreduction allows further adjuvant treatment. Early rehospitalization occurring within less than 30 days is linked to increased mortality.