Clinical Phenotypes of Tumors Invading the Rectosigmoid Colon Affecting the Extent of Debulking Surgery and Survival in Advanced Ovarian Cancer

Soo Jin Park, Jaehee Mun, Eun Ji Lee, Sunwoo Park, Sang Youn Kim, Whasun Lim, Gwonhwa Song, Jae-Weon Kim, Seungmee Lee, Hee Seung Kim, Soo Jin Park, Jaehee Mun, Eun Ji Lee, Sunwoo Park, Sang Youn Kim, Whasun Lim, Gwonhwa Song, Jae-Weon Kim, Seungmee Lee, Hee Seung Kim

Abstract

We classified clinical phenotypes based on tumor separability from the rectosigmoid colon and then evaluated the effect of these clinical phenotypes on surgical outcomes and prognosis of advanced ovarian cancer. We collected data of patients with stage IIIB-IVB disease who either underwent visceral segmental serosectomy (VSS) or low anterior resection (LAR) during maximal debulking surgery. All patients were divided into the following, according to the resection types of tumors involving the rectosigmoid colon: the focal (tumor-involved length <18 cm) and separable (FS) group that received VSS, the focal and inseparable (FI) that received LAR, or the diffuse (tumor-involved length ≥18 cm) group (D) that also received LAR. A total of 83 patients were included in FS (n=44, 53%), FI (n=18, 21.7%), and D (n=24, 25.3%) groups. FS and D groups with more extensive tumors were related to wider extent of surgery and more tumor infiltration except for bowels, whereas FI and D groups with more invasive tumors were associated with wider extent of surgery, more tumor infiltration to bowels, longer operation time, more blood loss, more transfusion, longer hospitalization, and higher surgical complexity scores. Moreover, FS and FI groups showed better progression-free survival than D group, whereas FS group demonstrated better overall survival than FI and D groups. Clinical phenotypes based on tumor separability from the rectosigmoid colon may depend on tumor invasiveness and extensiveness in advanced ovarian cancer. Moreover, these clinical phenotypes may affect surgical outcomes and survival.

Keywords: outcomes; ovarian cancer; phenotype; rectosigmoid; separability; survival.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Park, Mun, Lee, Park, Kim, Lim, Song, Kim, Lee and Kim.

Figures

Figure 1
Figure 1
Step-by-step procedures of visceral serosal segmentectomy. (A) Gross evaluation of the length of tumors involving the rectosigmoid colon; (B) Stripping of the tumors by electrocauterization; (C) Both right and left anterolateral edges are tagged, and the stripped surface of the bowel is folded; (D) Edges of the stripped area are closed with 3-0 vicryl sutures.
Figure 2
Figure 2
Clinical phenotypes by tumor separability (A) Focal and separable type (B) Focal and inseparable type (C) Diffuse type.
Figure 3
Figure 3
Comparison of survival using Kaplan-Meier method with log-rank and Breslow tests among the focal and separable (FS), focal and inseparable (FI), and diffuse groups (D) based on the resection types of tumor involving the rectosigmoid colon: (A) Progression-free survival; (B) Overall survival; Comparison of the survival proportion by Cox proportional hazards regression analysis among the focal and separable (FS), focal and inseparable (FI), and diffuse groups (D) based on the resection types of tumor involving the rectosigmoid colon: (C) Progression-free survival; (D) Overall survival.

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