Rectosigmoid resection without colostomy during primary cytoreductive surgery for ovarian carcinoma

A nine year experience with rectosigmoid colectomy during primary cytoreductive surgery for epithelial ovarian cancer is reported. During the period 1979-1987, 20 patients underwent such resections with primary sutured end-to-end anastomosis without a protecting colostomy. Only one of these patients required a secondary colostomy. In a further five patients, anterior resection and reanastomosis was performed concomitant with additional bowel resections, again without diversion colostomy. Subsequent secondary colostomy for a recto-vaginal fistula was required in one. There were two post-operative deaths, both in the group who required bowel resections in addition to recto-sigmoid resection. Of the entire group of 25 patients, 12 (48%) are currently alive free of disease, with a median survival of 32 months. Excluding the two post-operative deaths (at 20 and 39 days), the median survival of the remaining 11 who subsequently died of recurrent disease, was 14 months. The Authors recommend that anterior resection with primary reanastomosis without a protecting colostomy, is performed during primary cytoreductive surgery for ovarian cancer in patients in whom such a procedure facilitates resection of all or nearly all their disease.