EP225/#402 Factors contributing to surgeon's decision for diverting ileostomy at the time of cytoreductive surgery in patients with advanced ovarian cancer. (4th December 2022)

• Record Type: Journal Article
• Authors: Hogen, Liat; Salman, Lina; Siriwardena, Thirushi; Bernardini, Marcus; Ferguson, Sarah; Laframboise, Stephane; Bouchard-Fortier, Genevieve; Atenafu, Eshetu G; May, Taymaa
• Is Part Of: International journal of gynecological cancer. Volume 32(2022)Supplement 3
• Page Start: A141
• Page End: A141
• Publication Date: 2022-12-04
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2022-igcs.316
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objectives: Anastomotic leak (AL) occurs in 1.2–9% following cytoreductive surgery with large bowel resection (LBR) for advanced ovarian cancer (AOC) . Diverting ileostomy (DI) can mitigate the consequences of AL, however, is associated with compromised quality-of-life. Objectives: 1. Assess factors contributing to surgeon's decision to perform DI in AOC cytoreducation with LBR. 2. To study complications rates and survival outcomes. Methods: Retrospective cohort study, AOC patients, undergoing cytoreductive surgery with LBR and re-anastomosis between 01-Jan-2010–01-July-2020. Multivariable analysis was performed on factors contributing to DI on univariate analysis. Results: 140 patients met inclusion criteria; 57 patients (41%) had DI. Median follow-up was 32.1 months (0.3–59.74), median age 52 (26–86) Longer operative time (600 vs. 390 minutes), multiple bowel resections (>1 vs 1), pre-operative paracentesis, intra-operative ascites, positive air-leak-test were found to contribute to surgeons' decision for DI on univariate analysis. Multivariable analysis confirmed longer operative time (OR=1.71, p<0.0001), paracentesis (OR=3.47, p=0.05) and more than 1 bowel resection (OR=4.40, p=0.01) to be significant for this decision. AL rate was 3.65% (n=5). Patients with DI had higher rates of dehydration(41.5% vs 8.4%), acute kidney injury(17% vs 1.2%) and post-operative fever (26.4% vs 12%). Progression-free-survival (PFS) was similar (23.9 vs 21.3, no vs yes DI, p=0.61). Conclusions: Paracentesis, >1 bowel resection and longer operative time contributed to surgeon's decision to performed DI. Patients with DI had similar PFS to the non-DI group but experienced more post-operative complications. Developing prospective model to predict risk of AL may enable safe reduction in DI rates while maintaining acceptable AL rates.