Palliative surgery for intestinal complications of advanced, recurrent gynaecologic malignancy

A review of 45 consecutive patients who underwent operation for intestinal complications of recurrent gynaecologic cancer was undertaken to elucidate the efficacy of surgical treatment. The primary tumour was ovarian in 26 cases, endometrial in ten and cervical in nine cases. The overall operative mortality was 20%, morbidity 44%, and median survival time and postoperative symptom-free period 5 months and 3 months, respectively. Intestinal resection (n = 12) and bypass procedures (n = 10) carried the lowest mortality risk (8% and 10%). The corresponding figures for enterostomy (n = 15) and exploratory laparotomy (n = 8) were 33% and 25%. Resection gave significantly better survival rate and longer relief of symptoms than the other procedures. Resection and primary anastomosis seems to be the method of choice in low-risk cases. Patients with far advanced cancer or intraabdominal carcinomatosis should be treated surgically only if symptoms cannot be relieved with conservative treatment.