Chin Med J (Taipei) 1998;61:S40.

The Role of Intestinal Surgery in Patients with Ovarian Carcinoma

Ming-Shian Kao, M.D., F.R.C.S.(C), FACOG

Department of Obstetrics and Gynecology, St. Louis University School of Medicine Saint Louis, Missouri, U.S.A.

Abstract

Carcinoma of the ovary has the propensity to spread throughout the abdominal cavity in its early stage. A significant proportion of patients are found to have intestinal involvement at the time of initial laparotomy. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy and appropriate staging procedures together with optimal cytoreductive surgery has been correlated with a better prognosis. For patients with advanced staged disease, intestinal resection may be necessary to achieve the goal of removing all gross disease and to accomplish optimal cytoreduction.

The role of secondary debulking procedure with or without intestinal resection is still under investigation and intestinal surgery in this setting must be individualized.

Most patients who failed initial treatment with progressive or recurrent disease will eventually develop intestinal obstruction, frequently without involvement of other vital organ. Malnutrition, fluid and electrolyte imbalance, and cachexia secondary to intestinal obstruction is often the direct cause of death in the majority of patients with ovarian carcinoma. Management of intestinal obstruction in patients with ovarian carcinoma is often distinct from management of intestinal obstruction from other etiology. Palliative surgical procedure in the face of intestinal obstruction and progressive ovarian carcinoma is associated with high operative morbidity and mortality. Patient's age, expected survival time, nutritional status, extent of tumor, presence of ascites and the type of previous chemotherapy and/or radiation therapy must be carefully considered in making decision for a surgical intervention. Factors which may influence operability, morbidity, survival and quality of life following surgery will be discussed and guidelines will be recommended for intestianal surgery in patients with ovarian carcinoma.

[Chin Med J (Taipei) 1998;61:S40.]