Advanced ovarian cancer: urinary tract resection as a part of cytoreductive surgery

Maximum surgical effort to minimize residual tumor following primary surgery has been shown to increase mean survival in patients with epithelial ovarian cancer. From September, 1983 to November, 1987, 22 patients underwent resection of the urinary tract as a part of cytoreductive surgery. Seven patients underwent partial cystectomy, four underwent partial cystectomy with ureteroneocystotomy, five patients underwent ureteroneocystotomy while an additional four patients underwent ureteroureteral anastomosis. One patient underwent primary transverse colon conduit while another underwent a similar procedure after developing urinary leakage. All anastomoses were protected with indwelling stents while the urinary bladder was drained with an indwelling Foley catheter for ten days. Both patients requiring conduits had undergone prior radiation therapy in addition to chemotherapy. Nine major and two minor complications occurred in seven patients. One patient died six weeks postoperatively after concurrent hepatic resection. Optimal cytoreduction was possible in 59% of the patients, and was associated with a mean survival of 15.2 months. Optimal cytoreduction including resection of the urinary tract was associated with longer survival and acceptable morbidity and it appears to be justified in patients with ovarian cancer.