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Abstract
Objective
To evaluate survival impact of low anterior resection (LAR) in patients with epithelial ovarian cancer (EOC) grossly confined to the pelvis.
Methods
We retrospectively reviewed 397 patients who underwent primary staging surgery for treatment of 2014 International Federation of Gynecology and Obstetrics (FIGO) stage II–IIIA EOC: 116 (29.2%) IIA, 212 (53.4%) IIB, and 69 (17.4%) IIIA. Patients with grossly enlarged retroperitoneal lymph nodes positive for metastatic carcinoma were excluded. Of 92 patients (23.2%) with gross tumors at the rectosigmoid colon, 68 (73.9%) underwent tumorectomy and 24 (26.1%), LAR for rectosigmoid lesions. Survival outcomes between patients who underwent tumorectomy and LAR were compared using Kaplan-Meier curves.
Results
During the median follow-up of 55 months (range, 1–260), 141 (35.5%) recurrences and 81 (20.4%) deaths occurred. Age (52.8 vs. 54.5 years, p=0.552), optimal debulking (98.5% vs. 95.0%, p=0.405), histologic type (serous, 52.9% vs. 50.0%, p=0.804), FIGO stage (p=0.057), and platinum-based adjuvant chemotherapy ≥6 cycles (85.3% vs. 79.2%, p=0.485) were not different between groups. No significant difference in 5-year progression-free survival (PFS; 57.9% vs. 62.5%, p=0.767) and overall survival (OS; 84.7% vs. 63.8%, p=0.087), respectively, was noted between groups. Postoperative ileus was more frequent in patients subjected to LAR than those who were not (4/24 [16.7%] vs. 11/373 [2.9%], p=0.001). The 5-year PFS (60.3% vs. 57.9%, p=0.523) and OS (81.8% vs. 87.7%, p=0.912) between patients who underwent tumorectomy and those who did not were also similar.
References
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Fig. 1.
(A) The 5-year PFS (64.9%, 60.8%, and 47.0%; p=0.136) and (B) 5-year OS (84.3%, 80.3%, and 80.6%; p=0.423) in the whole study population (n=397) (solid line: FIGO stage IIA; dotted line: FIGO stage IIB; and dot-and-dash line: FIGO stage IIIA). FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival; PFS, progression-free survival.
Fig. 2.
(A) The 5-year PFS (57.9% vs. 62.5%, p=0.767) and (B) 5-year OS (84.7% vs. 63.8%, p=0.087) in patients who had rectosigmoid lesions (solid line: tumorectomy group [n=68]; dotted line: LAR group [n=24]). (C) The 5-year PFS (60.3% vs. 57.9%, p=0.523) and (B) 5-year OS (81.8% vs. 87.7%, p=0.912) in patients who did not receive LAR (solid line: no bowel surgery group [n=305]; dotted line: tumorectomy group [n=68]). LAR, low anterior resection; OS, overall survival; PFS, progression-free survival.
Table 1.
Patient characteristics (n=397)
| Characteristics | Value |
|---|---|
| Age (yr) | 51 (17–88) |
| Follow-up period (mo) | 55 (1–260) |
| Preoperative CA-125 (U/mL) | 161.0 (3.1–31,600.0) |
| Preoperative colonoscopy | |
| No | 197 (49.6) |
| Yes | 200 (50.4) |
| Rectosigmoid lesions | |
| Absent | 305 (76.8) |
| Present | 92 (23.2) |
| Rectum | 51 |
| Sigmoid colon | 13 |
| Unknown* | 28 |
| Bowel surgery | |
| No | 305 (76.8) |
| Tumorectomy | 68 (17.1) |
| LAR | 24 (6.1) |
| Optimal debulking | |
| No | 10 (2.5) |
| Yes | 335 (84.4) |
| Unknown* | 52 (13.1) |
| Histologic type | |
| Serous | 209 (52.6) |
| Non-serous | 188 (47.4) |
| FIGO stage | |
| IIA | 116 (29.2) |
| IIB | 212 (53.4) |
| IIIA | 69 (17.4) |
| Adjuvant chemotherapy (cycles) | 6 (0–20) |
| Adjuvant chemotherapy ≥6 cycles | |
| No | 62 (15.6) |
| Yes | 335 (84.4) |
| Recurrence | |
| No | 256 (64.5) |
| Yes | 141 (35.5) |
| Death | |
| No | 316 (79.6) |
| Yes | 81 (20.4) |
Table 2.
Univariate and multivariate analysis for independent risk factors of survival outcomes (n=397)
Table 3.
Comparisons of clinicopathologic factors (n=397)
| Characteristics | No bowel surgery (n=305) |
Tumorectomy (n=68) |
LAR (n=24) |
p‡ | ||
|---|---|---|---|---|---|---|
| Value | p* | Value | p† | |||
| Age (yr) | 52.0±11.5 | 52.8±11.4 | 0.618 | 54.5±12.7 | 0.552 | 0.567 |
| Preoperative CA-125 (U/mL) | 671.3±1,607.7 | 702.9±1,042.2 | 0.885 | 2,120.4±6,552.6 | 0.302 | 0.008 |
| Location of rectosigmoid lesions¶ | – | – | 0.759 | – | ||
| Rectum | 33 (78.6) | 18 (81.8) | ||||
| Sigmoid colon | 9 (21.4) | 4 (18.2) | ||||
| Optimal debulking¶ | 0.463 | 0.405 | 0.942 | |||
| No | 8 (3.1) | 1 (1.5) | 1 (5.0) | |||
| Yes | 249 (96.9) | 67 (98.5) | 19 (95.0) | |||
| Histologic type | 0.982 | 0.804 | 0.851 | |||
| Serous | 161 (52.8) | 36 (52.9) | 12 (50.0) | |||
| Non-serous | 144 (47.2) | 32 (47.1) | 12 (50.0) | |||
| FIGO stage | <0.001 | 0.057 | <0.001 | |||
| IIA | 113 (37.0) | 3 (4.4) | 0 | |||
| IIB | 145 (47.5) | 53 (77.9) | 14 (58.3) | |||
| IIIA | 47 (15.4) | 12 (17.7) | 10 (41.7) | |||
| Adjuvant chemotherapy (cycles) | 5.8±1.8 | 5.9±1.6 | 0.760 | 5.5±2.5 | 0.568 | 0.774 |
| Adjuvant chemotherapy ≥6 cycles | 0.884 | 0.485 | 0.650 | |||
| No | 47 (15.4) | 10 (14.7) | 5 (20.8) | |||
| Yes | 258 (84.6) | 58 (85.3) | 19 (79.2) | |||
| Recurrence | 0.623 | 0.669 | 0.883 | |||
| No | 198 (64.9) | 42 (61.8) | 16 (66.7) | |||
| Yes | 107 (35.1) | 26 (38.2) | 8 (33.3) | |||
| Death | 0.913 | 0.652 | 0.612 | |||
| No | 244 (80.0) | 54 (79.4) | 18 (75.0) | |||
| Yes | 61 (20.0) | 14 (20.6) | 6 (25.0) | |||
Table 4.
Operation-related outcomes and morbidity (n=397)
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