Can bowel endoscopy predict colorectal surgery in patients with an adnexal mass?

Abstract

The objective of this retrospective study was to identify the ability of preoperative endoscopy of the lower gastrointestinal tract and other tests to predict large bowel resection in patients with an adnexal mass. We reviewed 573 patients with a suspected adnexal mass admitted for surgery between 1987 and 1997. Two hundred fifty four patients (44%) had preoperative sigmoidoscopy (n = 97) or colonoscopy (n = 157). We identified patients who underwent a colorectal operation as part of their surgery and correlated surgical findings with the results of preoperative endoscopy, preexisting clinical symptoms, preoperative pelvic exam and ultrasonography, and the CA125 level. The sensitivity and positive predictive value of bowel endoscopy for predicting large bowel surgery were 18% and 59%, respectively. Multivariate analysis showed preexisting bowel-related symptoms, a pelvic exam suggestive of malignancy, a CA125 value >1000 U/ml, and infiltration of the colorectal wall at bowel endoscopy to be independently associated with subsequent colorectal surgery. We conclude that preoperative bowel endoscopy cannot accurately predict colon resection in patients with a suspected adnexal mass. Preexisting bowel-related symptoms, a pelvic exam suggestive of malignancy and a CA125 value >1000 U/ml are associated with subsequent colorectal surgery.

Preoperative colonoscopy in patients with a supposed primary ovarian cancer

“…The other works on this subject are similarly constructed. [15–17] However, colonoscopy findings are differently divided. None of them has a clearly distinguished degree and nature of constriction.…”

“…[16] Whereas Petru divided lesions into malignant infiltration or normal findings and the separate group of extrinsic compression. [17]…”

“…[15] Ravizza made initial diagnoses of OC on the basis of physical examination, computed tomography (CT) and the level of Ca 125, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (Ca 19.9) in blood. [16] The number of confirmed primary OCs was usually slightly above 60%; in Petru study – 64%, [17] in Gornall study – 66%. [15]…”

“…However, there are studies that negate the need for colonoscopy. [16,17] In addition, colonoscopy is not a standard procedure of preoperative workup in patients with a supposed OC.…”

Intestinal surgery in advanced ovarian cancer

“…However, in recent years studies have documented that preoperative bowel endoscopy cannot accurately predict colon resection in patients with a suspected adnexal mass [26,27 ]. Preexisting bowel-related symptoms, a pelvic exam suggestive of malignancy, and a CA125 level more than 1000 units/ml are associated with subsequent colorectal surgery [26]. Hence, in a patient with suspected ovarian carcinoma, it is important to plan surgery so that bowel resection can be performed as needed.…”