Factors Limiting Ostomy Reversal After Cytoreductive Surgery for Ovarian Cancer: A Retrospective Study.

IF 1.6 4区 医学 Q4 ONCOLOGY Anticancer research Pub Date : 2024-10-01 DOI:10.21873/anticanres.17270
Beatriz Navarro Santana, Frederic Guyon, Octavio Arencibia, Guillaume Babin, Eudaldo Tommasetti, Daniel González, Sabrina Piedimonte, Alicia Martín Martínez
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Abstract

Background/aim: To investigate the factors related to non-reversal of ostomy after cytoreductive surgery in ovarian cancer. In many women with ovarian cancer, transitory ostomies are performed to limit the consequences of anastomotic leak. Although intended to be temporary, a proportion of these ostomies might never be reversed.

Patients and methods: This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a transitory ostomy during primary or secondary cytoreductive surgery at the Bergonie Institute, France, and the University Hospital of Las Palmas, Spain, between January 2012 and December 2022. Rate of ostomy reversal, its timing (weeks) and postoperative complications were assessed. Multivariate logistic regression analysis was performed to identify limiting factors for ostomy reversal.

Results: During the study period, we reviewed data on 181 consecutive patients with ovarian cancer with transitory ostomy creation; 89 (49.2%) patients were not candidates for an ostomy reversal surgery because of disease progression (n=65), death (n=16), and patient's refusal of surgery (n=8). A total of 92 patients were candidates for reversal surgery and were therefore included in the final analysis. In total, 57 (62%) patients had their ostomy reversed. The mean time from ostomy creation to ostomy closure was 47.7 (standard deviation=33.1) weeks. Hartmann's procedure (leaving a rectal stump of 5-6 cm) was identified as an independent predictive factor for non-reversal of ostomy (odds ratio=6.42, 95% confidence interval=1.61-25.53; p=0.008). Complications after ostomy reversal occurred in 32 patients (34.8%).

Conclusion: Hartmann's procedure is a limiting factor for ostomy reversal in patients with ovarian cancer. We recommend avoiding Hartmann's procedure during cytoreductive surgery, even after colorectal anastomotic leak.

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卵巢癌清创手术后限制造口术逆转的因素:一项回顾性研究
背景/目的:研究卵巢癌细胞切除手术后不逆行造口术的相关因素。在许多卵巢癌女性患者中,为了限制吻合口漏造成的后果,需要实施过渡性造口术。虽然这些造口是临时性的,但其中一部分可能永远无法逆转:这是一项回顾性研究,研究对象是2012年1月至2022年12月期间在法国贝戈尼研究所(Bergonie Institute)和西班牙拉斯帕尔马斯大学医院(University Hospital of Las Palmas)接受初级或二级细胞减灭术、需要临时造口的2014年国际妇产科联盟IIB-IVB期卵巢癌患者。对造口翻转率、时间(周)和术后并发症进行了评估。我们进行了多变量逻辑回归分析,以确定造口翻转的限制因素:在研究期间,我们回顾了连续 181 例卵巢癌患者的数据,其中有 89 例(49.2%)患者因疾病进展(65 例)、死亡(16 例)和患者拒绝手术(8 例)而不适合接受造口翻转手术。共有 92 名患者符合逆转手术的条件,因此被纳入最终分析。共有 57 名患者(62%)接受了造口翻转手术。从造口建立到造口关闭的平均时间为 47.7 周(标准差=33.1 周)。哈特曼手术(留下 5-6 厘米的直肠残端)被认为是不逆转造口的独立预测因素(几率比=6.42,95% 置信区间=1.61-25.53;P=0.008)。32名患者(34.8%)在逆转造口术后出现并发症:结论:哈特曼手术是卵巢癌患者逆转造口术的限制因素。结论:哈特曼手术是卵巢癌患者进行造口翻转术的限制因素,我们建议在进行细胞切除手术时避免哈特曼手术,即使是在结直肠吻合口漏之后。
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来源期刊
Anticancer research
Anticancer research 医学-肿瘤学
CiteScore
3.70
自引率
10.00%
发文量
566
审稿时长
2 months
期刊介绍: ANTICANCER RESEARCH is an independent international peer-reviewed journal devoted to the rapid publication of high quality original articles and reviews on all aspects of experimental and clinical oncology. Prompt evaluation of all submitted articles in confidence and rapid publication within 1-2 months of acceptance are guaranteed. ANTICANCER RESEARCH was established in 1981 and is published monthly (bimonthly until the end of 2008). Each annual volume contains twelve issues and index. Each issue may be divided into three parts (A: Reviews, B: Experimental studies, and C: Clinical and Epidemiological studies). Special issues, presenting the proceedings of meetings or groups of papers on topics of significant progress, will also be included in each volume. There is no limitation to the number of pages per issue.
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