Palliative Surgery

For many patients with recurrent ovarian cancer, the progressive encasement of the small and large bowel with tumor results in bowel obstruction. Palliative surgery to relieve the obstruction is often successful but fraught with complications. In a review of the published literature on surgery for intestinal obstruction in ovarian cancer, Pothuri and colleagues50 analyzed 694 patients who underwent attempts at surgical

Months
Patients at risk:

RD = 0 mm

133

78

40

8

1

RD = 1-10 mm

69

38

15

3

0

RD > 10 mm

65

37

11

3

0

Figure 7-21. Influence of residual disease (RD) after cytoreductive surgery for recurrence on overall survival (OS). HR, hazard ratio. (From Harter P, Bois A, Hahmann M, et al: Surgery in recurrent ovarian cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial. Ann Surg Oncol 13:1702-1710, 2006, Figure 1.)

Time (in months)

Figure 7-22. Survival according to the number of recurrence sites based on radiographic imaging.

Patients who had one or two recurrence sites had a median survival of 50 months, and patients who had from three to five recurrence sites had a median survival of 12 months (P = .026). (From Salani R, Santillan A, Zahurak ML, et al: Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: analysis of prognostic factors and survival outcome. Cancer 109:685-691, 2007, Figure 4.)

palliation. Ninety percent of these were able to be surgically corrected. The perioperative mortality rate among these patients was 15.5%, and the rate of major operative complications was noted to be 32%. In addition, the median survival after surgery was 4.1 months and up to 50% of patients suffer from re-obstruction.51 Jong and associates52 have identified the presence of multiple obstructive sites, a preoperative weight loss of more than 9 kg, poor nutritional status, and a history of pelvic or abdominal radiation as indicative of a lower likelihood of successful palliation. For patients who are poor surgical candidates or who refuse palliative surgery, the placement of a percutaneous gastrostomy tube offers an option for palliation of nausea and vomiting due to intestinal obstruction.53

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