Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug;142(2):217-24.
doi: 10.1016/j.ygyno.2016.05.035. Epub 2016 Jun 4.

Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes

Jill H Tseng  1 , Rudy S Suidan  1 , Oliver Zivanovic  2 , Ginger J Gardner  2 , Yukio Sonoda  2 , Douglas A Levine  2 , Nadeem R Abu-Rustum  2 , William P Tew  3 , Dennis S Chi  2 , Kara Long Roche  4
Affiliations

Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes

Jill H Tseng et al. Gynecol Oncol. 2016 Aug.

Abstract

Objective: To examine the use, as well as postoperative and long-term oncologic outcomes of diverting loop ileostomy (DI) during primary debulking surgery (PDS) for ovarian cancer.

Methods: Patients with stage II-IV ovarian, fallopian tube, or primary peritoneal carcinoma who underwent colon resection during PDS from 1/2005-1/2014 were identified. Demographic and clinical data were analyzed.

Results: Of 331 patients, 320 (97%) had stage III/IV disease and 278 (84%) had disease of high-grade serous histology. Forty-four (13%) underwent a DI. There were no significant differences in age, comorbidity index, smoking status, serum albumin, or attending surgeon between the DI and non-DI groups. Operative time (OR=1.21; 95% CI, 1.03-1.42; p=0.02) and length of rectosigmoid resection (OR=1.04; 95% CI, 1.01-1.08; p=0.02) were predictors of DI on multivariable analysis. The overall anastomotic leak rate was 6%. A comparison of groups (DI vs non-DI) showed no significant differences in major complications (30% vs 23%; p=0.41), anastomotic leak rate (5% vs 7%; p=0.60), hospital length of stay (10 vs 9days; p=0.25), readmission rate (23% vs 17%; p=0.33), or interval to postoperative chemotherapy (41 vs 40days; p=0.20), respectively. Ileostomy reversal was successful in 89% of patients. Median follow-up was 52.6months. There were no differences in median progression-free (17.9 vs 18.6months; p=0.88) and overall survival (48.7 vs 63.8months; p=0.25) between the groups.

Conclusions: In patients undergoing PDS, those with longer operative time and greater length of rectosigmoid resection more commonly underwent DI. DI does not appear to compromise postoperative outcomes or long-term survival.

Keywords: Anastomotic leak; Diverting ileostomy; Ovarian cancer; Postoperative outcomes; Primary debulking surgery; Rectosigmoid resection.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement The authors declare that there are no financial or commercial conflicts of interest.

Figures

Figure 1
Figure 1
Timing of ileostomy reversal. (A) Interval from primary debulking surgery to ileostomy reversal. (B) Timing of ileostomy reversal in relation to postoperative chemotherapy administration.
Figure 2
Figure 2
Kaplan-Meier survival curves for progression-free survival (A) and overall survival (B) in patients who underwent diverting ileostomy and those who did not.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016 Jan;66(1):7–30. - PubMed
    1. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002 Mar 1;20(5):1248–1259. - PubMed
    1. Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, et al. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg. 2008 Jun;32(6):1147–1156. - PubMed
    1. Obermair A, Hagenauer S, Tamandl D, Clayton RD, Nicklin JL, Perrin LC, et al. Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer. Gynecol Oncol. 2001 Oct;83(1):115–120. - PubMed
    1. Mourton SM, Temple LK, Abu-Rustum NR, Gemignani ML, Sonoda Y, Bochner BH, et al. Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer. Gynecol Oncol. 2005 Dec;99(3):608–614. - PubMed

Publication types