RESULTS
The present study represents an 8-year retrospective review of operative
procedures in patients with early ovarian cancer at a single
institution. Fifty-two patients were identified within the study period
(Table 1). Most patients had ovarian cancer (n=50); one patient had
tubal cancer and one patient had primary peritoneal carcinoma.
Thirty-seven and 15 patients were identified and comprised of the
current FIGO stage I and II groups, respectively. The median age of the
patients was 46-year-old (range, 22-70 year). Twelve patients (23%) had
serous histology. The remaining 40 patients (77%) had non-serous
histology: mucinous, 9 (17%); endometrioid, 11 (21%); clear cell
carcinoma, 14 (27%), transitional cell, 2 (4%) and; mixed carcinoma, 4
(8%). Architecture grade 3 tumours were found in 13 (25%) patients.
Serum CA-125 was checked preoperatively in 50 patients (96%); 27
patients (54%) had elevated serum CA-125 level (>35 U/mL).
The medical value of serum CA-125 was 43 U/mL (range, 8-4389 U/mL). The
co-existence of endometriosis was identified in 16 (31%) patients. The
endometriosis was identified in adnexa, 6 (12%); rectum, 5 (10%);
adnexa and rectum, 2 (4%); and pelvic peritoneum, 3(6%).
Table 2 details the surgical procedures performed in 52 patients.
Forty-five patients (87%) underwent hysterectomy; five patients had
undergone hysterectomy because of myoma in the past and the uterus was
preserved in two patients. Fifty patients (96%) underwent bilateral
salpingooophorectomies; unilateral ovary and salpinx were preserved in
two patients. Pelvic peritonectomy was performed with hysterectomy and
salpingooophorectomy to remove all suspicious metastatic lesions. Pelvic
and paraaortic lymph node dissection was performed in 45 (87%) and 46
(88%) patients, respectively. All 52 patients underwent omentectomy.
Thirty-nine patients (75%) underwent appendectomies; the appendix was
missed at the time of diagnosis of ovarian cancer because the appendix
had been removed in 4 and 3 patients for appendicitis and incidental
appendectomy, respectively. Resection of the rectosigmoid colon was
performed in 15 patients for complete removal of suspicious metastatic
lesions. The rectal wall was adherent to surrounding tissues such as the
uterus, adnexa, and pelvic peritoneum in 10 patients and obliteration
between the rectum and surrounding tissue was identified in 5 patients.
Splenectomy was performed in one patient for splenic injury and in one
patient for complete removal of suspicious metastatic disease.
Cholecystectomy was performed in 2 patients because of chronic
cholecystitis and gallstone, respectively. Small bowel resection and
re-anastomosis were performed in two patients because of adhesion from
the previous operation. Diaphragmatic peritonectomy was performed in a
patient with stage 1 huge mucinous cystadenocarcinoma for complete
removal of a suspicious metastatic lesion. Ileostomy was performed in
one patient who revealed a positive leakage test at anastomosis between
the rectal stump and sigmoid colon and the reversal of ileostomy was
repaired 1 year later. One case of external iliac vein laceration
measuring 8 mm was managed with a vascular suture using Prolene 4–0.
Ureteroneocystostomy was performed in one patient for complete removal
of all suspicious lesions at lower urinary tract who revealed left
hydroureteronephrosis suggesting infiltrative tumour invasion. One
patient underwent ureteroureterostomy for intraoperative ureteral
injury. With these surgical procedures, complete cytoreduction was
attained in all patients.
Table 3 described surgical outcomes. The median operation time was 328
minutes. The median estimated blood loss was 400mL. Eleven patients
received transfusion; the median transfusion was 2 pints. Postoperative
complications occurred in 23% of patients, the most common being mild
ileus (5 patients). Four patients experienced febrile morbidity, which
improved with conservative management. Wound dehiscence was noticed in
three patients. Atelectasis was identified in three patients. Pancreatic
juice leakage, arrhythmia, and lymphedema were identified in a patient,
respectively. All these complications were well managed with
conservative management. Rectovaginal fistula or leakage was not
identified in all 15 patients who underwent resection of the
rectosigmoid colon. The median day for flatus passage and tolerable diet
was 3 and 5 days from surgery, respectively. Forty-two patients received
adjuvant chemotherapy; the median day of adjuvant chemotherapy from
surgery was 13 days. The median postoperative hospital stay was 12 days.
Pathological outcomes of resection of the rectosigmoid colon were
summarized in Table 4. Of 15 patients with resection of the rectosigmoid
colon, cancer invasion and endometriosis were identified at resected
rectum in 6 (40.0%) and 5 (33.3%) patients, respectively (Fig 1).
Superficial invasion (up to serosa or subserosa) and deep invasion (up
to muscle or mucosa) of cancer were identified in 3 and 3 patients,
respectively. Superficial invasion and deep invasion of endometriosis
were identified in 4 and 1 patient, respectively. Fibrosis and/or
adhesion were identified in 4 patients. Peri-adnexal endometriosis was
identified in 2 patients and another 2 patients had previous operation
history.
The median follow-up of 52 patients was 50 months (range, 8-98). The
5-year disease-free survival rate was 85.9%. All patients have survived
at the time of the current analysis.