Clinical analysis of different intestinal reconstruction methods after primary cytoreductive surgery combined with rectal resection for advanced ovarian cancer
Objective: To compare different intestinal reconstruction methods after intestinal resection for advanced ovarian malignancy.Methods: Retrospective data of patients with advanced ovarian malignancy were collected and then assigned into three groups: primary intestinal anastomosis, protective enterostomy and colostomy. General clinical characteristics, intraoperative findings and postoperative outcomes were compared between the three groups.Results: A total of 530 cases were included for final analysis. The colostomy group had a lower serum albumin level, larger volume of ascites, higher likelihood of multiple intestinal resections and lower likelihood of rectal resection, lower peritoneal cancer index, more intraoperative blood loss, transfusions and infusions, lower likelihood of optimal cytoreductive surgery and shorter interval time to chemotherapy than the other two groups (p < 0.05). The primary intestinal anastomosis group exhibited a larger blood transfusion volume, higher incidence rates of anastomotic leak and electrolyte disturbance, and longer times to first flatus, first feeding and drain removal than the other two groups (p < 0.05).Conclusions: Colostomy can be adopted for advanced ovarian cancer patients with a large ascites volume, hypoproteinemia, large intraoperative blood and fluid loss volumes, multiple intestinal resections, anastomoses located below the peritoneal reflection, high PCI and suboptimal cytoreductive surgery. For patients with good intraoperative and postoperative outcomes, one anastomosis, an anastomosis located above the peritoneal reflection, low PCI or optimal cytoreductive surgery, intestinal anastomosis can be carried out to restore the normal physiological function of the intestine. For patients with a large volume of ascites (≥500 mL), multiple anastomoses or an anastomosis located below the peritoneal reflection, intestinal anastomosis combined with protective enterostomy has an advantage over intestinal anastomosis alone.