Could systematic ileostomy decrease anastomotic leakage after modified posterior exenteration in advanced stage...

Cytoreductive surgery for advanced epithelial ovarian cancer (EOC) often requires complex bowel procedures. Anastomotic leakage remains a major concern, and the role of protective stomas is still debated. This study compares two centers with contrasting strategies: Center A (proactive routine protective ileostomy) and Center B (restrictive policy).

We retrospectively analyzed 122 patients with stage III-IV epithelial ovarian cacner undergoing cytoreductive surgery and bowel resection at Center A (n = 54) and Center B (n = 68). Primary endpoints were Anastomotic leakage rate and survival. A multivariate analysis using Firth's penalized likelihood regression adjusted for differences in surgical complexity (peritoneal cancer index, completeness of cytoreduction score, lymphadenectomy).

Baseline characteristics were similar, though Center B had significantly higher mean peritoneal cancer index (15.4 vs. 9.5; p < 0.001) and complete cytoreduction rates (p = 0.04). Protective ileostomy was performed in 68.5% of cases in Center A and 0% in Center B. Overall complication rates were comparable (p = 0.65). Anastomotic leakage occurred exclusively in Center B (10.3%, n = 7; p = 0.017). In multivariate analysis, the absence of protective ileostomy remained a strong clinical predictor of anastomotic leakage, showing a borderline statistically significant trend toward protection (OR 0.144, 95% CI 0.001-1.400; p = 0.075) after adjusting for complexity. No significant differences were observed in recurrence, overall survival or disease-free survival.

A proactive protective ileostomy policy significantly reduces the clinical impact of anastomotic leakage. This effect remains clinically evident even after adjusting for higher disease burden and surgical radicality, without impairing long-term survival.