Studies from the colorectal literature have shown that factors associated with anastomotic leak after colorectal resection include long surgical time (>2 h), multiple blood transfusions, and short distance to the a...Studies from the colorectal literature have shown that factors associated with anastomotic leak after colorectal resection include long surgical time (>2 h), multiple blood transfusions, and short distance to the anal verge. The aim of this study was to assess the morbidity associated with en bloc resection of ovarian carcinoma with low anterior resection and anastomosis in patients undergoing primary cytoreductive surgery for advanced disease. Methods. We performed a retrospective chart review of all patients who had undergone primary cytoreduction for advanced epithelial ovarian cancer with rectosigmoid resection followed by low rectal anastomosis between January 1994 and June 2004. Patient characteristics, operative details, and postoperative complications were extracted from patients’ charts. Results. Seventy patients met the above criteria and form our study group. The median age was 59 years (range, 25- 82). There were 52 stage IIIC (74% ) and 18 stage IV (26% ) cancers. The median operating time was 315 min (range, 120- 750) and the median estimated blood loss was 1200 ml (range, 250- 8000), with 53 (76% ) patients requiring blood transfusion. Twenty-eight patients (40% ) underwent major upper abdominal procedures other than omentectomy, and 14 patients (20% ) underwent a second bowel resection. Twelve patients (17% ) underwent a protective ileostomy while the remainder (83% ) did not. Of the 58 patients with no ostomy, the only complications associated with the resection and anastomoses were a pelvic abscess in 3 patients (5% ) and an anastomotic leak requiring diverting colostomy in 1 patient (1.7% ). Of the 12 patients who had protective ileostomies, 3 (25% ) had complications related to their ileostomy short-bowel syndrome requiring early reversal, incarceration of the prolapsed loop requiring surgical correction, and prolapse corrected electively at the time of second-look surgery. Conclusions. In women undergoing primary cytoreductive surgery, the morbidity associated with en bloc resection of ovarian carcinoma with low rectosigmoid resection and anastomosis without protective ileostomy was acceptably low, with an anastomotic leak rate of less than 2% . Protective ileostomy is not always necessary and should be used selectively.展开更多
Objective. To determine the potential of dividing vascular pedicles by stapling to reduce operative time, blood loss, and morbidity associated with cytoreductive operations for advanced ovarian cancer. Methods. A case...Objective. To determine the potential of dividing vascular pedicles by stapling to reduce operative time, blood loss, and morbidity associated with cytoreductive operations for advanced ovarian cancer. Methods. A case- control study was undertaken to compare operative outcomes for patients undergoing primary cytoreductive operations for ovarian cancer using two different operative strategies. Between 2002 and 2004, both stapling and conventional techniques were used to divide vascular pedicles for 50 consecutive patients requiring modified posterior exenterations (en- bloc resection of internal reproductive organs, pelvic peritoneum, and recto- sigmoid colon) and upper abdominal procedures in the context of primary cytoreduction for stage IIIC and IV ovarian cancer. The operative time, blood loss, transfusion rate, hospitalization, and incidence of complications were compared to outcomes of 50 consecutive patients operated on between 1994 and 1997 for whom stapling was not used to divide pedicles (chi- square test for binomial data, and t- test analysis for continuous data). Results. Both groups were equivalent with respect to disease severity, extent of upper abdominal surgery, and cytoreductive outcomes. The group for whom stapling devises were used to divide pedicles had a significantly reduced total operative time 179 min vs. 284 min, P < 0.001), estimated blood loss (1170 ml vs. 1782 ml, P = 0.004), and transfusion rate (3.6 units packed red cells vs. 5.0 units packed red blood cells, P = 0.03). Conclusion. Stapling of vascular pedicles significantly reduces the operative time and blood loss for patients undergoing extensive primary cytoreductive operations for advanced ovarian cancer.展开更多
文摘Studies from the colorectal literature have shown that factors associated with anastomotic leak after colorectal resection include long surgical time (>2 h), multiple blood transfusions, and short distance to the anal verge. The aim of this study was to assess the morbidity associated with en bloc resection of ovarian carcinoma with low anterior resection and anastomosis in patients undergoing primary cytoreductive surgery for advanced disease. Methods. We performed a retrospective chart review of all patients who had undergone primary cytoreduction for advanced epithelial ovarian cancer with rectosigmoid resection followed by low rectal anastomosis between January 1994 and June 2004. Patient characteristics, operative details, and postoperative complications were extracted from patients’ charts. Results. Seventy patients met the above criteria and form our study group. The median age was 59 years (range, 25- 82). There were 52 stage IIIC (74% ) and 18 stage IV (26% ) cancers. The median operating time was 315 min (range, 120- 750) and the median estimated blood loss was 1200 ml (range, 250- 8000), with 53 (76% ) patients requiring blood transfusion. Twenty-eight patients (40% ) underwent major upper abdominal procedures other than omentectomy, and 14 patients (20% ) underwent a second bowel resection. Twelve patients (17% ) underwent a protective ileostomy while the remainder (83% ) did not. Of the 58 patients with no ostomy, the only complications associated with the resection and anastomoses were a pelvic abscess in 3 patients (5% ) and an anastomotic leak requiring diverting colostomy in 1 patient (1.7% ). Of the 12 patients who had protective ileostomies, 3 (25% ) had complications related to their ileostomy short-bowel syndrome requiring early reversal, incarceration of the prolapsed loop requiring surgical correction, and prolapse corrected electively at the time of second-look surgery. Conclusions. In women undergoing primary cytoreductive surgery, the morbidity associated with en bloc resection of ovarian carcinoma with low rectosigmoid resection and anastomosis without protective ileostomy was acceptably low, with an anastomotic leak rate of less than 2% . Protective ileostomy is not always necessary and should be used selectively.
文摘Objective. To determine the potential of dividing vascular pedicles by stapling to reduce operative time, blood loss, and morbidity associated with cytoreductive operations for advanced ovarian cancer. Methods. A case- control study was undertaken to compare operative outcomes for patients undergoing primary cytoreductive operations for ovarian cancer using two different operative strategies. Between 2002 and 2004, both stapling and conventional techniques were used to divide vascular pedicles for 50 consecutive patients requiring modified posterior exenterations (en- bloc resection of internal reproductive organs, pelvic peritoneum, and recto- sigmoid colon) and upper abdominal procedures in the context of primary cytoreduction for stage IIIC and IV ovarian cancer. The operative time, blood loss, transfusion rate, hospitalization, and incidence of complications were compared to outcomes of 50 consecutive patients operated on between 1994 and 1997 for whom stapling was not used to divide pedicles (chi- square test for binomial data, and t- test analysis for continuous data). Results. Both groups were equivalent with respect to disease severity, extent of upper abdominal surgery, and cytoreductive outcomes. The group for whom stapling devises were used to divide pedicles had a significantly reduced total operative time 179 min vs. 284 min, P < 0.001), estimated blood loss (1170 ml vs. 1782 ml, P = 0.004), and transfusion rate (3.6 units packed red cells vs. 5.0 units packed red blood cells, P = 0.03). Conclusion. Stapling of vascular pedicles significantly reduces the operative time and blood loss for patients undergoing extensive primary cytoreductive operations for advanced ovarian cancer.
