• anastomotic leakage
• multivisceral surgery
• ovarian cancer
• risk factors
• stoma formation
• survival

• Humans
• Female
• Anastomotic Leak/etiology
• Anastomotic Leak/epidemiology
• Ovarian Neoplasms/surgery
• Ovarian Neoplasms/mortality
• Ovarian Neoplasms/pathology
• Middle Aged
• Risk Factors
• Cytoreduction Surgical Procedures/adverse effects
• Lymph Node Excision/adverse effects
• Aged
• Adult

• HGSOC metastatic intraperitoneal mouse model
• HGSOC orthotopic Xenograft model
• apoptosis
• cell cycle
• chromosomal instability
• high-grade serous ovarian cancer
• in vitro-transcribed p53-mRNA
• liposomal IVT mRNA delivery system
• patient-derived organoid
• patient-derived primary cancer cell

• Animals
• Mice
• Humans
• Female
• Tumor Suppressor Protein p53/genetics
• RNA, Messenger/genetics
• Neoplasm Grading
• Cell Line, Tumor
• Ovarian Neoplasms/drug therapy
• Ovarian Neoplasms/genetics
• Chromosomal Instability
• Mammals

• 70114007 Deutsche Krebshilfe
• 2021.023.1 Wilhelm Sander Stiftung
• Deutsche Krebshilfe

• colorectal resection
• cytoreductive surgery
• gynecological oncology surgery
• ovarian cancer
• transitory protective stoma

• abdominal drainage
• anastomosis leakage
• debulking surgery
• ovarian cancer
• rectosigmoid resection
• stoma

Bowel resection is often required to obtain complete removal of ovarian cancer. A major complication of this operation is anastomotic leakage, which has been shown to increase morbidity and mortality in this population. Numerous original research studies have assessed the risk factors for anastomotic leaks. We aimed to conduct a systematic review and meta-analysis to identify statistically significant risk factors. This meta-analysis identified multiple bowel resections as the only significant risk factor. With further research to identify additional risk factors, new management guidelines could be implemented to minimize the risk of anastomotic leaks and improve patient outcomes.

Introduction: Anastomotic leaks (AL) following ovarian cytoreduction surgery could be detrimental, leading to significant delays in commencing adjuvant chemotherapy, prolonged hospital stays and increased morbidity. The aim of this study was to investigate risk factors associated with anastomotic leaks after ovarian cytoreduction surgery. Material and methods: The MEDLINE (via PubMed), Cochrane Library, EMBASE and Scopus bibliographical databases were searched. Original clinical studies investigating risk factors for AL in ovarian cytoreduction surgery were included. Results: Eighteen studies with non-overlapping populations reporting on patients undergoing cytoreduction surgery for ovarian cancer (n = 4622, including 344 cases complicated by AL) were included in our analysis. Patients undergoing ovarian cytoreduction surgery complicated by AL had a significantly higher rate of 30-day mortality but no difference in 60-day mortality. Multiple bowel resections were associated with an increased risk of postoperative AL, while no association was observed with body mass index (BMI), American Society of Anesthesiologists (ASA) score, age, smoking, operative approach (primary versus interval cytoreductive, stapled versus hand-sewn anastomoses and formation of diverting stoma), neoadjuvant chemotherapy and use of hyperthermic intraperitoneal chemotherapy (HIPEC). Discussion: Multiple bowel resections were the only clinical risk factor associated with increased risk for AL after bowel surgery in the ovarian cancer population. The increased 30-day mortality rate in patients undergoing ovarian cytoreduction complicated by AL highlights the need to minimize the number of bowel resections in this population. Further studies are required to clarify any association between neoadjuvant chemotherapy and decreased AL rates.

• Anastomotic leak
• Ovarian cancer
• Score

• Carcinoma, Ovarian Epithelial/pathology
• Carcinoma, Ovarian Epithelial/surgery
• Controlled Clinical Trials as Topic
• Cytoreduction Surgical Procedures
• Disease Progression
• Female
• Humans
• Observational Studies as Topic
• Ovarian Neoplasms/pathology
• Ovarian Neoplasms/surgery
• Treatment Outcome

Posterior pelvic exenteration (PPE) can be required to achieve complete resection in ovarian cancer (OC) patients with large pelvic disease. This study aimed to analyze morbidity, complete resection rate, and survival of PPE.

Ninety patients who underwent PPE in our Comprehensive Cancer Center between January 2010 and February 2021 were retrospectively identified. To analyze practice evolution, 2 periods were determined: P1 from 2010 to 2017 and P2 from 2018 to 2021.

A 82.2% complete resection rate after PPE was obtained, with rectal anastomosis in 96.7% of patients. Complication rate was at 30% (grade 3 in 9 patients), without significant difference according to periods or quality of resection. In a binary logistic regression adjusted on age and stoma, only age of 51–74 years old was associated with a lower rate of complication (odds ratio=0.223; p=0.026). Median overall and disease-free survivals (OS and DFS) from initial diagnosis were 75.21 and 29.84 months, respectively. A negative impact on OS and DFS was observed in case of incomplete resection, and on DFS in case of final cytoreductive surgery (FCS: after ≥6 chemotherapy cycles). Age ≥75-years had a negative impact on DFS for new OC surgery. For patients with complete resection, OS and DFS were decreased in case of interval cytoreductive surgery and FCS in comparison with primary cytoreductive surgery.

PPE is an effective surgical measure to achieve complete resection for a majority of patients. High rate of colorectal anastomosis was achieved without any mortality, with acceptable morbidity and high protective stoma rate.

Posterior-pelvic-exenteration (PPE) can be required to achieve complete cyto-reductive-surgery (CS) in ovarian cancer (OC) patients. A 82.2% complete-CS rate was obtained for PPE, with rectal anastomosis in 96.7%. Complication rate was 30%. Negative impact on DFS for patients with incomplete-CS or final-CS or age ≥75-years for new OC and PPE.

• Anastomotic leakage
• Bowel surgery
• Colorectal anastomosis
• Ovarian cancer
• Rectosigmoid resection

• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Carcinoma, Ovarian Epithelial
• Cytoreduction Surgical Procedures
• Female
• Humans
• Ovarian Neoplasms/surgery

• Anastomotic leak
• Colorectal resection
• Hyperthermic intraperitoneal chemotherapy
• Interval debulking surgery
• Ovarian cancer

The aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer.

We performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used.

Two hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001).

EOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

• Early oral feeding
• Ovarian cancer
• Postoperative hospital stay
• Postoperative morbidity
• Rectosigmoid resection

• Adhesion
• Early stage
• Ovarian cancer
• Rectosigmoid colectomy
• Survival outcome

• Ovarian cancer
• colectomy
• cytoreductive surgery
• en bloc pelvic resection with rectosigmoid colectomy
• optimal debulking
• ovarian neoplasms/surgery
• ovariectomy/methods
• radical oophorectomy

• Ovarian cancer (OC)
• cytoreductive surgery
• diaphragm
• residual tumor

High-grade serous ovarian carcinoma (HGSOC) is a leading cause of mortality among women worldwide. Currently, there is no clear consensus over the regime these patients should receive. The main two options are upfront debulking surgery with adjuvant chemotherapy or neoadjuvant chemotherapy followed by interval debulking surgery (IDS). The former approach is proposed to be accompanied by lower chemoresistance rates but could lead to severe surgical comorbidities and lower quality of life (QoL). Optimizing patient’s selection for upfront debulking surgery might offer higher progression-free and overall survival rates. Further studies need to be conducted in order to elucidate the predictive factors, which are favorable for patients undergoing upfront debulking surgery in cases of high-grade serous ovarian cancer.

• Upfront debulking surgery
• chemotherapy
• cytoreductive surgery
• high-grade serous ovarian cancer
• interval debulking surgery (IDS)

To evaluate the survival rate of patients with advanced ovarian carcinoma in relation to the type of surgical intervention – total abdominal hysterectomy with bilateral adnexectomy and omentectomy as a minimal standard compared to extended hysterectomy with a retroperitoneal approach.

The study was implemented based on retrospectively obtained data from 104 patients operated on for advanced epithelial ovarian carcinoma (FIGO stages II-IV) in the period from 2004 to 2012. Total abdominal hysterectomy, bilateral adnexectomy, and omentectomy were performed on 23 patients. Extended hysterectomy with a retroperitoneal approach and varying degrees of peritonectomy, omentectomy, and appendectomy were performed on 74 patients. Seven patients were treated with adnexectomy or biopsy alone. We divided the patients into two groups according to the mode of surgery. The first one comprised the patients who underwent radical hysterectomy and the second one comprised total abdominal hysterectomy plus bilateral adnexectomy. The two groups were examined for their overall survival rate, relapse-free survival rate, and 5-year survival rate.

Mean overall survival rate, relapse-free survival rate, and 5-year survival rate in the group with extended hysterectomy were higher compared to the group with total abdominal hysterectomy.

The extended hysterectomy with a retroperitoneal approach with or without systematic lymph node dissection seems to be more appropriate in the surgical treatment of advanced ovarian carcinoma. The procedure is related to the improvement of survival rate as a result of the inclusion of macroscopically invisible lesions in the surgical removal.

• 5-year survival rate
• ovarian carcinoma
• overall survival
• radical hysterectomy

“En-bloc” resection of pelvic tumor in ovarian cancer (OC) is still controversial. The aim was to analyze results in an OC series from a single center, all of whom underwent “en-bloc” resection as part of cytoreductive surgery.

Clinical and surgical records from sixty patients with ovarian carcinoma who underwent “en-bloc” resection surgery were retrospectively analyzed.

Patients’ mean age was 56 years; 36 patients had primary disease and 24 had recurrent disease. Carcinomatosis was present in 46.7% of patients. Primary surgery was performed in 49 and interval debulking surgery in eleven. Complete cytoreduction was achieved in 55.0% and optimal in 38.3% of patients. Carcinomatosis significantly decreased the probability of complete cytoreduction [odds ratio (OR): 0.22; p=0.021]. Mesorectal infiltration occurred in 83% of patients. Risk of death was non-significantly higher (hazard ratio: 1.9) in women with mesorectal infiltration. Median overall survival was longer for patients without infiltration (46.1 vs 79.1 months; p=0.15). Eighty-five percent suffered from mild to moderate complications and colorectal anastomosis (CRA) leak occurred in two patients (3.6%) with CRA below 6 cm. Diaphragm resection had >5 times the risk for major complications (OR: 5.35; p=0.014). There was no three month mortality.

When contiguous gross extension of disease to pelvic peritoneum and sigmoid colon is found, in patients with advanced OC, microscopic involvement of the mesorectum and intestinal wall is present in most cases making “en-bloc” resection necessary if complete cytoreduction is to be achieved. The associated morbidity is acceptable.

• Ovarian cancer
• surgery
• rectosigmoid

• Anastomotic leak
• Diverting ileostomy
• Ovarian cancer
• Risk factors

• anastomotic leak
• complications
• ghost ileostomy
• ovarian cancer

• Adult
• Aged
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Anastomotic Leak
• Colon/surgery
• Conservative Treatment/methods
• Cytoreduction Surgical Procedures/methods
• Female
• Humans
• Ileostomy/methods
• Middle Aged
• Neoplasm Staging
• Ovarian Neoplasms/pathology
• Ovarian Neoplasms/surgery
• Rectum/surgery

• Anastomotic leak
• Ovarian cancer
• Risk factors

• Bowel resection
• Ovarian cancer

• Adult
• Aged
• Aged, 80 and over
• Anal Canal/pathology
• Anal Canal/surgery
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Anastomotic Leak/epidemiology
• Anastomotic Leak/prevention & control
• Catheterization/adverse effects
• Catheterization/instrumentation
• Catheterization/methods
• Drainage/adverse effects
• Drainage/instrumentation
• Drainage/methods
• Female
• Humans
• Middle Aged
• Ovarian Neoplasms/epidemiology
• Ovarian Neoplasms/surgery
• Pelvic Exenteration/adverse effects
• Pelvic Exenteration/instrumentation
• Pelvic Exenteration/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Retrospective Studies
• Treatment Outcome

• Aortic lymph nodes
• Bowel infiltration
• Mesenteric lymph nodes
• Ovarian cancer
• Pelvic lymph nodes

• Colectomy
• Cytoreductive surgery
• Digestive system
• Ovarian cancer
• Risk factors
• Surgical procedures

• Advanced stage ovarian cancer
• peritonectomy
• rectosigmoidian loop
• resection

• Adult
• Aged
• Clinical Decision-Making
• Colon, Sigmoid/pathology
• Cytoreduction Surgical Procedures/adverse effects
• Cytoreduction Surgical Procedures/methods
• Female
• Humans
• Intraoperative Care/adverse effects
• Intraoperative Care/methods
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Staging
• Ovarian Neoplasms/pathology
• Ovarian Neoplasms/surgery
• Rectum/pathology

• Cytoreduction
• Ovarian cancer
• Ultra-radical surgery

• Leakage
• anastomosis
• colorectal resection
• gynaecological cancer

The resection of all visible malignancies increases the likelihood for long-term survival in epithelial ovarian cancer. The complete extinguishment of pelvic disease is possible using en bloc pelvic resection. The no-touch isolation technique aims to reduce cancer cells flowing from the primary tumor site to the liver and other organs by ligating blood and lymphatic vessels first. objectives are to present the operative details and to establish the feasibility of the modified technique of en bloc pelvic resection, which begins with the central ligation of vessels supplying the tumor bed.

Twenty patients with pelvic tumor extensively infiltrating into adjacent pelvic organs were uniformly operated on. The surgical plan commenced with incisions along the lateral peritoneal reflections immediately medial to the white line of Toldt followed by a retroperitoneal central ligation of ovarian and mesenteric vessels and the ovarian lymphovascular flow. Then, the routine steps of en bloc pelvic resection were performed. Data on treatment were assessed.

In all cases, no gross residual disease was achieved. The median durations of the surgical procedure and the hospital stay were 320 min (range: 205–430 min) and 12 days (range: 7–44 days), respectively. The complications were as follows: wound infection (n = 1), anastomosis dehiscence (n = 1), total parenteral nutrition (n = 4), and death (n = 1, PE). The median follow-up time period was 19 months (range: 8–31 months). No patient experienced a recurrence of pelvic disease.

Performing a central ligation of vessels supplying the tumor bed prior to an en bloc pelvic resection is feasible with acceptable morbidity and mortality rates.

• Complete pelvic peritonectomy
• Cytoreduction
• En bloc pelvic resection
• No-touch isolation
• Ovarian cancer
• Surgery

• Bowel surgery
• Ovarian cancer
• Primary debulking surgery
• Quality of life

To achieve optimal cytoreduction for advanced-stage ovarian cancer, modified posterior exenteration is the most frequently performed bowel surgery. We assessed the extents of tumor spreading in the rectosigmoid wall and pelvic side wall in modified posterior exenteration specimens during primary debulking surgery (PDS) and interval debulking surgery (IDS) following neoadjuvant chemotherapy, and compared the validity of selecting this surgical procedure in the patients undergoing PDS with that in the patients undergoing IDS.

Clinicopathological data from consecutive patients who had undergone a modified posterior exenteration for primary ovarian, tubal, and peritoneal cancer at our institution between April 2008 and March 2013 was retrospectively reviewed.

A total of 75 patients (38 in PDS and 37 in IDS) were included in this study. Tumor involvement of the rectosigmoid was histopathologically confirmed in 65 % of the specimens. Though the extent of tumor spreading in the rectosigmoid was deeper in PDS than in IDS, the frequency of tumor involvement of the rectosigmoid in patients who had undergone modified posterior exenteration during PDS was equivalent to that in the IDS group. Lateral tumor spreading to the side wall(s) was histopathologically confirmed in 53 % of the patients in whom a pelvic side wall resection had been performed.

During both PDS and IDS for ovarian cancer presenting with tumor involvement of the cul-de-sac, close inspection and palpation by gynecologic oncologists may enable the extent of tumor spreading in the pelvis to be estimated, enabling valid decisions as to whether an en bloc resection of the pelvic tumors together with the rectosigmoid and the pelvic side wall might or might not be appropriate.

Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients (about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy (CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease (RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefit of surgery. It’s still undefined how the intrinsic features of the tumor make intra-abdominal implants easier to remove. Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the definition of RD is not universal. A unique and definitive definition is needed.

• Ovarian cancer
• Cytoreduction
• Complete
• Hyperthermic intraperitoneal chemotherapy

• Retrograde hysterectomy
• Retroperitoneal hysterectomy
• Total laparoscopic hysterectomy

Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.