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

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

Research output: Contribution to journalArticle

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 9. days; . p = 0.25), readmission rate (23% vs 17%; . p = 0.33), or interval to postoperative chemotherapy (41 vs 40. days; . p = 0.20), respectively. Ileostomy reversal was successful in 89% of patients. Median follow-up was 52.6. months. There were no differences in median progression-free (17.9 vs 18.6. months; . p = 0.88) and overall survival (48.7 vs 63.8. months; . 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.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - May 10 2016
Externally publishedYes

Keywords

  • Anastomotic leak
  • Diverting ileostomy
  • Ovarian cancer
  • Postoperative outcomes
  • Primary debulking surgery
  • Rectosigmoid resection

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

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  • Cite this

    Tseng, J. H., Suidan, R. S., Zivanovic, O., Gardner, G. J., Sonoda, Y., Levine, D. A., Abu-Rustum, N. R., Tew, W. P., Chi, D. S., & Roche, K. L. (Accepted/In press). Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2016.05.035