Comparison of posterior rectal dissection techniques during rectosigmoid colon resection as part of cytoreductive surgery in patients with epithelial ovarian cancer: Close rectal dissection versus total mesorectal excision

Son, Joo-Hyuk; Kim, Jeeyeon; Shim, Jin‐Hyung; Kong, Tae-Wook; Paek, Jiheum; Chang, Suk-Joon; Ryu, Hee Sug

doi:10.1016/j.ygyno.2019.02.029

Cited by 15 publications

(15 citation statements)

References 16 publications

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“…An en bloc resection of the rectosigmoid together with the uterus, tubes/ovaries, and the pelvic tumors, also known as modi ed posterior pelvic exenteration or radical oophorectomy, is one of the most frequently performed types of surgical procedures during cytoreductive surgery for advanced ovarian cancer [4][5][6][7]. Anastomotic leakage remains a life-threatening potential complication of rectosigmoid resections despite advances in surgical techniques and medical instrumentation [8,9]. As cytoreductive surgery aimed at complete resection requires the removal of multiple organs and the resection of extensive amounts of the peritoneum, it is usually complicated and invasive.…”

Section: Introductionmentioning

confidence: 99%

Early oral Feeding is Safe and Useful after Rectosigmoid Resection with Anastomosis During Cytoreductive Surgery for Primary Ovarian Cancer

Kato

Omatsu

Okamoto

et al. 2020

Preprint

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BackgroundThe aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer.MethodsWe performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer during a 7-year period. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol during the middle of the study period. Before the introduction of EOF, conventional oral feeding (COF) had been used.ResultsTwo hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range: 2–8) in the COF group and 2 (range: 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range: 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001).ConclusionEOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

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Section: Introductionmentioning

confidence: 99%

Early oral Feeding is Safe and Useful after Rectosigmoid Resection with Anastomosis During Cytoreductive Surgery for Primary Ovarian Cancer

Kato

Omatsu

Okamoto

et al. 2020

Preprint

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“…Some authors suggest that a close colorectal dissection (CRD) without a partial mesorectum excision or adequate longitudinal margin may leave residual tumor in the mesorectum or in the intestinal wall and this is not consistent with the complete disease resection concept (7)(8)(9)(10)(13)(14)(15)(16)(17)(18)(19)(20)(21). A recent study comparing sigmoidectomy with total mesorectal resection (TMR) and without mesorectal resection for removing focal disease did not find difference in progression free survival and concluded that CRD could be an acceptable alternative (27).…”

Section: Discussionmentioning

confidence: 99%

“…CRA leak occurred in 3.6% (range, 0% to 9.0%), proximal fecal stream diversion was performed in 18.8% (range, 0% to 58.4%), major complications occurred in 23.3% and death in 1% (range, 0-6%) of the cases, respectively. Recently several (27,30). The series from Korea (27) compares the rate of CRA leakage according to whether a TMR or a CRD were performed and they showed a higher rate for TMR (5.3 vs 0%).…”

Section: Discussionmentioning

confidence: 99%

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En-bloc rectosigmoid and mesorectum resection as part of pelvic cytoreductive surgery in advanced ovarian cancer

Marchand

Azadi²,

Sainz

et al. 2020

J Turkish German Gynecol Assoc

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Objective: "En-bloc" resection of pelvic tumor in ovarian cancer (OC) is still controversial. The aim was to analyze results in an OC series from a single center, all of whom underwent "en-bloc" resection as part of cytoreductive surgery. Material and Methods: Clinical and surgical records from sixty patients with ovarian carcinoma who underwent "en-bloc" resection surgery were retrospectively analyzed. Results: Patients' mean age was 56 years; 36 patients had primary disease and 24 had recurrent disease. Carcinomatosis was present in 46.7% of patients. Primary surgery was performed in 49 and interval debulking surgery in eleven. Complete cytoreduction was achieved in 55.0% and optimal in 38.3% of patients. Carcinomatosis significantly decreased the probability of complete cytoreduction [odds ratio (OR): 0.22; p=0.021]. Mesorectal infiltration occurred in 83% of patients. Risk of death was non-significantly higher (hazard ratio: 1.9) in women with mesorectal infiltration. Median overall survival was longer for patients without infiltration (46.1 vs 79.1 months; p=0.15). Eighty-five percent suffered from mild to moderate complications and colorectal anastomosis (CRA) leak occurred in two patients (3.6%) with CRA below 6 cm. Diaphragm resection had >5 times the risk for major complications (OR: 5.35; p=0.014). There was no three month mortality. Conclusion: When contiguous gross extension of disease to pelvic peritoneum and sigmoid colon is found, in patients with advanced OC, microscopic involvement of the mesorectum and intestinal wall is present in most cases making "en-bloc" resection necessary if complete cytoreduction is to be achieved. The associated morbidity is acceptable.

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“…EOC often spreads into the peritoneal cavity along the peritoneal surface and makes tumor deposits on the serosa of rectosigmoid colon first, then invades into the muscular layers followed by the mucosa, which is the opposite of the direction in colorectal cancer. In fact, studies have shown that there was no difference in pelvic recurrence or progression free survival (PFS) between the patients with advanced EOC who received rectosigmoid colectomy by the CRD technique versus the TME technique (16). They further showed that rectosigmoid colectomy by the CRD technique was associated with less anastomotic leakage and low incidence of prolonged ileus over 7 days in comparison with the TME technique, presumably due to the preserved blood supply (16).…”

Section: Role Of Rectosigmoid Colectomy To Achieve Optimal Debulkingmentioning

confidence: 99%

En bloc pelvic resection of ovarian cancer with rectosigmoid colectomy: a literature review

2021

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Maximal cytoreductive surgery is an important prognostic factor in advanced epithelial ovarian cancer (EOC). To achieve maximal cytoreductive surgery, en bloc pelvic resection with rectosigmoid colectomy can be an effective surgical strategy. This surgical methodology was first described in 1968 as "radical oophorectomy." Since then, it has been adopted by many medical institutions around the world, and its safety has been shown by many studies. However, research on the surgical method is still lacking due to the limited number of prospective comparative studies. We will review the journals on en bloc pelvic resection with rectosigmoid colectomy published to date and discuss its efficacy, complications, and surgical techniques of the procedures.

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Comparison of posterior rectal dissection techniques during rectosigmoid colon resection as part of cytoreductive surgery in patients with epithelial ovarian cancer: Close rectal dissection versus total mesorectal excision

Cited by 15 publications

References 16 publications

Early oral Feeding is Safe and Useful after Rectosigmoid Resection with Anastomosis During Cytoreductive Surgery for Primary Ovarian Cancer

Early oral Feeding is Safe and Useful after Rectosigmoid Resection with Anastomosis During Cytoreductive Surgery for Primary Ovarian Cancer

En-bloc rectosigmoid and mesorectum resection as part of pelvic cytoreductive surgery in advanced ovarian cancer

En bloc pelvic resection of ovarian cancer with rectosigmoid colectomy: a literature review

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