Transitory Stoma at the Time of Complete Cytoreductive Surgery Affects Survival for Patients with Advanced-stage Ovarian Cancer

Abstract

Aim: To evaluate the influence on relapse-free survival (RFS) and overall survival (OS) of a transitory protective stoma (TPS) at the time of complete cytoreductive surgery for advanced-stage ovarian cancer.

Patients and methods: From our Institution, we retrospectively selected patients from 2006 to 2011 with ovarian cancer with the following criteria: stage IIIB to IVA (pleural effusion) according to the International Federation of Gynaecology and Obstetrics classification; complete cytoreductive surgery (CC0 according to Sugarbaker's classification); and a low anterior resection. We evaluated the influence on relapse-free survival (RFS) and overall survival (OS) of a transitory protective stoma (TPS).

Results: Nine patients were identified with and 90 without TPS. We found no difference between these two groups in terms of age, body mass index, histological subtype, grade, initial cancer antigen 125 level, type of surgery, Peritoneal Cancer Index score and the interval between surgery and adjuvant chemotherapy. Two out of the nine patients (22%) in the TPS group had adhered to the chemotherapy schedule versus 52/90 (58%) in the no-TPS group (p<0.05). Eight out of the nine patients with a TPS had undergone stomal closure with a median delay of 25 weeks (5-40 weeks). In the univariate analysis using the log-rank test, undergoing an ileostomy at the time of cytoreductive surgery was significantly associated with decreased OS (p=0.003) and RFS (p=0.001). In the multivariate analysis, a TPS was associated with a higher risk of recurrence (p=0.002).

Conclusion: An ileostomy at the time of complete CRS negatively affects survival in patients with advanced-stage ovarian cancer.

Keywords: Transitory stoma; diverting ileostomy; ileostomy closure; ileostomy reversal; ovarian cancer; rectosigmoidresection.