The role of multiple bowel resections in advanced ovarian cancer: survival and surgical outcomes—a narrative review

: Ovarian cancer (OC) is the fifth most common cancer-related cause of death in women and the most lethal gynecologic malignancies in developed countries. In more than two thirds of the cases it is diagnosed as an advanced stage disease. The treatment requires a surgical step, aiming to remove the macroscopically visible disease, either as a primary debulking surgery or interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). In both cases radical, complex and invasive surgical procedures are needed in order to achieve complete resection of the tumor, frequently involving bowel surgery. Considering the spread of the disease in the abdominal cavity, involvement of multiple bowel segments is common. Multiple bowel resections (MBR) are often needed to a complete cytoreduction but are linked to a higher rate of bowel diversion and postoperative morbidity, including severe postoperative complications, as anastomotic leakage (AL), and even death. These complications not only affect short term morbidity but may even postpone the administration of adjuvant chemotherapy, thus significantly affecting the outcomes of the treatment. NACT may help reducing the aggressiveness of debulking surgery and therefore the rate of its complications. This strategy represents a valid therapeutic option, especially in fragile patients, reducing the surgical related morbidity and the risk of bowel resections, without affecting the overall survival.