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

Fingerprint

Ileostomy
Ovarian Neoplasms
Anastomotic Leak
Operative Time
Length of Stay
neoplasm-associated factor
Survival
Fallopian Tubes
Serum Albumin
Comorbidity
Histology
Colon
Smoking
Demography
Carcinoma
Drug Therapy

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Tseng, J. H., Suidan, R. S., Zivanovic, O., Gardner, G. J., Sonoda, Y., Levine, D. A., ... 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

Diverting ileostomy during primary debulking surgery for ovarian cancer : Associated factors and postoperative outcomes. / Tseng, Jill H.; Suidan, Rudy S.; Zivanovic, Oliver; Gardner, Ginger J.; Sonoda, Yukio; Levine, Douglas A.; Abu-Rustum, Nadeem R.; Tew, William P.; Chi, Dennis S.; Roche, Kara Long.

In: Gynecologic Oncology, 10.05.2016.

Research output: Contribution to journalArticle

Tseng, JH, Suidan, RS, Zivanovic, O, Gardner, GJ, Sonoda, Y, Levine, DA, Abu-Rustum, NR, Tew, WP, Chi, DS & Roche, KL 2016, '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
Tseng, Jill H. ; Suidan, Rudy S. ; Zivanovic, Oliver ; Gardner, Ginger J. ; Sonoda, Yukio ; Levine, Douglas A. ; Abu-Rustum, Nadeem R. ; Tew, William P. ; Chi, Dennis S. ; Roche, Kara Long. / Diverting ileostomy during primary debulking surgery for ovarian cancer : Associated factors and postoperative outcomes. In: Gynecologic Oncology. 2016.
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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.",
keywords = "Anastomotic leak, Diverting ileostomy, Ovarian cancer, Postoperative outcomes, Primary debulking surgery, Rectosigmoid resection",
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T2 - Associated factors and postoperative outcomes

AU - Tseng, Jill H.

AU - Suidan, Rudy S.

AU - Zivanovic, Oliver

AU - Gardner, Ginger J.

AU - Sonoda, Yukio

AU - Levine, Douglas A.

AU - Abu-Rustum, Nadeem R.

AU - Tew, William P.

AU - Chi, Dennis S.

AU - Roche, Kara Long

PY - 2016/5/10

Y1 - 2016/5/10

N2 - 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.

AB - 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.

KW - Anastomotic leak

KW - Diverting ileostomy

KW - Ovarian cancer

KW - Postoperative outcomes

KW - Primary debulking surgery

KW - Rectosigmoid resection

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