[Clinical analysis of postoperative intestinal dysfunction in patients with advanced epithelial ovarian cancer]

Objective: To analyze the factors influencing early [postoperative prolonged ileus (PPOI)] and late [low anterior resection syndrome (LARS)] bowel dysfunction after primary cytoreductive surgery in patients with advanced ovarian cancer, and to evaluate the economic impact of postoperative bowel dysfunction. Methods: A retrospective study was conducted on 275 patients with advanced epithelial ovarian cancer who underwent cytoreductive surgery at the First Affiliated Hospital of Air Force Medical University from January 2020 to December 2024. Patients were grouped based on postoperative bowel dysfunction: PPOI group (n=59) and non-PPOI group (n=216). Among 119 patients who underwent rectosigmoid resection, 77 completed questionnaire assessment and were included in LARS analysis, categorized into LARS group (n=30) and non-LARS group (n=47). Perioperative clinical data were collected, and univariate and multivariate logistic regression models were used to identify risk factors for PPOI and LARS. Results: A total of 275 patients with a mean age of (56.7±9.1) years were included, of whom 21.5% (59/275) developed PPOI. Among 77 patients who completed LARS assessment [mean age (55.2±10.1) years], 39.0% (30/77) developed LARS. Multivariate analysis showed that preoperative prognostic nutritional index (PNI)≤45 (OR=3.059, 95%CI: 1.481-6.593), history of prior abdominal surgery (OR=2.511, 95%CI: 1.196-5.274), total psoas area index (TPAI)≤266.2 mm²/m² (OR=7.725, 95%CI: 3.621-16.483), intraoperative rectal resection (OR=6.816, 95%CI: 3.143-14.782), and total pelvic peritonectomy (OR=2.947, 95%CI: 1.372-6.328) were independent risk factors for PPOI (all P<0.05). Total pelvic peritonectomy (OR=3.547, 95%CI: 1.048-11.612) was identified as a risk factor for LARS (P=0.036). Furthermore, the PPOI group had significantly higher hospitalization costs and longer hospital stays (all P<0.001). Conclusions: Poor preoperative nutritional status and specific surgical procedures are risk factors for PPOI after cytoreductive surgery in advanced ovarian cancer patients, with total pelvic peritonectomy being a common risk factor for both PPOI and LARS. Additionally, PPOI increases the economic burden of medical care.