Factors Limiting Ostomy Reversal After Cytoreductive Surgery for Ovarian Cancer: A Retrospective Study

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Transitory ostomies are common in ovarian cancer surgery to manage anastomotic leaks.
• A significant proportion of these ostomies are not reversed, impacting patient quality of life.
• Identifying factors influencing ostomy reversal is crucial for optimizing patient care.

Purpose of the Study:

• To investigate factors associated with the non-reversal of temporary ostomies in ovarian cancer patients.
• To determine the rate and timing of ostomy reversal after cytoreductive surgery.
• To identify predictive factors for ostomy non-reversal.

Main Methods:

• Retrospective analysis of 181 ovarian cancer patients (stages IIB-IVB) who underwent cytoreductive surgery with transitory ostomy creation.
• Assessment of ostomy reversal rates, timing, and postoperative complications.
• Multivariate logistic regression to identify limiting factors for ostomy reversal.

Main Results:

• Of 181 patients, 89 were ineligible for reversal due to disease progression, death, or refusal.
• 57 out of 92 eligible patients (62%) underwent ostomy reversal, with a mean reversal time of 47.7 weeks.
• Hartmann's procedure was identified as an independent predictor of ostomy non-reversal (OR=6.42, p=0.008).

Conclusions:

• Hartmann's procedure is a significant limiting factor for ostomy reversal in ovarian cancer patients.
• Avoiding Hartmann's procedure during cytoreductive surgery is recommended to improve ostomy reversal rates.
• Further research may explore alternative surgical techniques to facilitate ostomy reversal.