Journal List > J Gynecol Oncol > v.29(4) > 1148309

Kim, Suh, Park, Paik, Lee, Eoh, Nam, Lee, Kim, and Kim: Survival impact of low anterior resection in patients with epithelial ovarian cancer grossly confined to the pelvic cavity: a Korean multicenter study

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.

Conclusion

Survival benefit of LAR did not appear to be significant in EOC patients with grossly pelvis-confined tumors.

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.
jgo-29-e60f1.tif
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.
jgo-29-e60f2.tif
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)

Values are presented as number (%) or median (range). CA-125, cancer antigen-125; FIGO, International Federation of Gynecology and Obstetrics; LAR, Low anterior resection.

* Without descriptions on operation records.

Table 2.
Univariate and multivariate analysis for independent risk factors of survival outcomes (n=397)
Characteristics Univariate
Multivariate
  HR (95% CI) p HR (95% CI) p
PFS
 Age ≥51 yr 0.973 (0.645–1.468) 0.898    
 Presence of rectosigmoid lesion 1.085 (0.668–1.761) 0.742    
 Invasion depth of rectosigmoid lesion > subserosa 1.846 (0.525–6.487) 0.339    
 Bowel surgery (tumorectomy vs. LAR) 1.238 (0.465–3.297) 0.669    
 Residual tumor ≥0.5 cm 1.828 (1.029–3.249) 0.040 1.716 (0.960–3.066) 0.068
 Residual tumor ≥1.0 cm 1.226 (0.339–4.431) 0.756    
 Histology of non-serous 1.259 (0.834–1.901) 0.272    
 FIGO stage ≥ IIB 1.402 (0.881–2.230) 0.154 1.664 (0.995–2.784) 0.052
 FIGO stage ≥ IIIA 1.299 (0.763–2.211) 0.334    
OS
 Age ≥51 yr 1.206 (0.739–1.966) 0.454    
 Presence of rectosigmoid lesion 1.111 (0.629–1.963) 0.717    
 Invasion depth of rectosigmoid lesion > subserosa 2.684 (0.739–9.746) 0.133 3.261 (0.838–12.692) 0.088
 Bowel surgery (tumorectomy vs. LAR) 1.286 (0.430–3.844) 0.653    
 Residual tumor ≥0.5 cm 2.145 (1.136–4.048) 0.019 2.129 (1.124–4.033) 0.020
 Residual tumor ≥1.0 cm 1.000 (0.208–4.818) >0.999    
 Histology of non-serous 1.334 (0.818–2.177) 0.248    
 FIGO stage ≥ IIB 1.331 (0.761–2.328) 0.316    
 FIGO stage ≥ IIIA 1.103 (0.586–2.076) 0.762    

CI, confidence interval; FIGO, International Federation of Gynecology and Obstetrics; HR, hazard ratio; LAR, low anterior resection; OS, overall survival; PFS, progression-free survival.

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)    

Values are presented as number (%) or mean±standard deviations. CA-125, Cancer antigen-125; FIGO, International Federation of Gynecology and Obstetrics; LAR, Low anterior resection.

* No bowel surgery vs. tumorectomy;

Tumorectomy vs. LAR;

Among 3 groups;

In patients with available data.

Table 4.
Operation-related outcomes and morbidity (n=397)
Characteristics No LAR (n=373) LAR (n=24) p
Operation time (min) 232.7±80.6 390.4±142.8 <0.001
Estimated blood loss (mL) 570.2±539.0 856.3±753.3 0.015
Ileus     0.001
 No 362 (97.1) 20 (83.3)  
 Yes 11 (2.9) 4 (16.7)  
Bowel leakage     >0.999
 No 372 (99.7) 24 (100.0)  
 Yes 1 (0.3) 0  
Fever >3 days     0.519
 No 365 (97.9) 23 (95.8)  
 Yes 8 (2.1) 1 (4.2)  
Wound dehiscence     0.271
 No 355 (95.2) 24 (100.0)  
 Yes 18 (4.8) 0  

LAR, low anterior resection.

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