Abstract
Purpose: To investigate the factors related to non-reversal of ostomy after cytoreductive surgery in ovarian cancer. In many women with ovarian cancer, transitory ostomies are performed to limit the consequences of anastomotic leak. Although intended to be temporary, a proportion of these ostomies might never be reversed
Methods: This was a retrospective study of patients with 2014 FIGO stage IIB-IVB ovarian cancer requiring a transitory ostomy during primary or secondary cytoreductive surgery at Institute Bergonie, France and University Hospital of Las Palmas, Spain between January 2012 and December 2022. Rate, timing (weeks) and postoperative complications of ostomy reversal were assessed. Multivariate logistic regression analysis was performed to identify limiting factors for ostomy reversal.
Results: During the study period we reviewed data on 181 consecutive ovarian cancer patients with transitory ostomy creation. A total of 89 (49.2%) patients were not candidate for an ostomy reversal surgery because of disease progression (n=65), death (n=16), and patient´s refusal of surgery (n=8). So, 92 patients were candidate for a reversal surgery and therefore included in final analysis. In total, 57 (62%) patients had their ostomy reversed. Mean time from ostomy creation to ostomy closure was 47.7 weeks (±33.1). Hartmann’s procedure (leaving a rectal stump of 5-6cm) was identified as an independent predictive factor for non-reversal of ostomy [OR 6.42 (1.61-25.53), p=0.008]. Complications after ostomy reversal occurred in 32 patients (34.8%).
Conclusions:
Hartmann´s procedure is a limiting factor for ostomy reversal. We recommend avoiding Hartmann´s procedure during cytoreductive surgery and even after colorectal anastomotic leak.