A clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian and primary peritoneal cancers

Melissa A. Gerardi, Antonio Santillan, Benjamin Meisner, Marianna L. Zahurak, Teresa P. Diaz Montes, Robert L. Giuntoli, Robert E. Bristow

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives.: To evaluate the safety, feasibility, and economic impact of a clinical pathway, including rapid diet advancement, for patients undergoing rectosigmoid colectomy as part of cytoreductive surgery for advanced ovarian and primary peritoneal cancers. Methods.: Between 8/1/98 and 6/30/06, 64 consecutive patients met study inclusion criteria. Using case-control methodology, post-operative management was dictated by a prescribed clinical pathway in 19 patients (Group A) and directed by individual surgeon preference in 45 patients (Group B). Critical elements of the clinical pathway included: rapid diet advancement, early discontinuance of nasogastric suction, criteria-based utilization of parenteral nutrition, selective laboratory testing, and deferring initiation of chemotherapy until after discharge. Results.: Stage IIIC/IV disease was present in 94% of all patients. The median time to flatus was 6 days for both groups (p = 0.95); however, the median time to tolerance of diet was 3 days for Group A and 6 days for Group B (p = 0.013). Compared to Group B, patients in Group A had a significantly shorter median length of hospital stay (7 days vs 10 days, p = 0.014) and lower median 30-day post-operative hospital cost ($19,700 vs $25,110, p = 0.028), with no significant difference in 30-day readmission rate (21% vs 33%, p = 0.379). Clinical pathway-directed management was associated with a median reduction in hospital cost of $5410 per patient. Conclusions.: A critical pathway incorporating rapid diet advancement for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for ovarian and primary peritoneal cancers is feasible, safe, and associated with a significant reduction in length of hospital stay and hospital-related costs.

Original languageEnglish (US)
Pages (from-to)282-286
Number of pages5
JournalGynecologic oncology
Volume108
Issue number2
DOIs
StatePublished - Feb 2008

Keywords

  • Clinical pathway
  • Ovarian cancer
  • Rectosigmoid colectomy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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