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Postoperative Intestinal Fistula in Primary Advanced Ovarian Cancer Surgery

Authors Llueca A, Serra A, Climent MT, Maiocchi K, Villarin A, Delgado K, Mari-Alexandre J, Gilabert-Estelles J, Carrasco P, Segarra B, Gomez L, Hidalgo JJ, Escrig J, Laguna M

Received 5 September 2020

Accepted for publication 27 November 2020

Published 6 January 2021 Volume 2021:13 Pages 13—23


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Harikrishna Nakshatri

Antoni Llueca,1– 3 Anna Serra,1– 3 Maria Teresa Climent,1,2 Karina Maiocchi,2,4 Alvaro Villarin,2,4 Katty Delgado,2,5 Josep Mari-Alexandre,6 Juan Gilabert-Estelles,6,7 Paula Carrasco,3 Blanca Segarra,8 Luis Gomez,2,4 Juan Jose Hidalgo,3 Javier Escrig,3 Manuel Laguna2,4 On behalf of the MUAPOS working group (Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery

1Department of Gynecology and Obstetrics, University General Hospital of Castellon, Castellón, Spain; 2Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain; 3Department of Medicine, University Jaume I (UJI), Castellon, Spain; 4Department of General Surgery, University General Hospital of Castellon, Castellón, Spain; 5Department of Radiology, University General Hospital of Castellon, Castellón, Spain; 6Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain; 7Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain; 8University of Texas MD Anderson Cancer Center, Gynecology Oncology, Houston, Texas, USA

Correspondence: Antoni Llueca Email

Background: Advanced ovarian cancer (AOC) requires an aggressive surgery with large visceral resections in order to achieve an optimal or complete cytoreduction and increase the patient’s survival. However, the surgical aggressiveness in the treatment of AOC is not exempt from major complications, such as the gastrointestinal fistula (GIF), which stands out among others due to its high morbidity and mortality.
Methods: We evaluated the clinicopathological features in patients with AOC and their association with GI. Data for 107 patients with AOC who underwent primary debulking surgery were analyzed retrospectively. Clinicopathological features, including demographic, surgical procedures and follow-up data, were analyzed in relation to GIF.
Results: GIF was present in 11% of patients in the study, 5 (4.5%) and 7 (6.4%) of colorectal and small bowel origin, respectively. GIF was significantly associated with peritoneal cancer index (PCI) > 20, more than 2 visceral resections, and multiple digestive resections. Overall and disease-free survival were also associated with GIF. Multivariate analysis identified partial bowel obstruction and operative bleeding as independent prognostic factors for survival. The presence of GIF is positively associated with poor prognosis in patients with AOC.
Conclusion: Given the importance of successful cytoreductive surgery in AOC, the assessment of the amount of tumor and the aggressiveness of the surgery to avoid the occurrence of GIF become a priority in patients with AOC.

Keywords: advanced ovarian cancer surgery, complications, intestinal leakage, intestinal fistula

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