Palliative Surgery for Bowel Obstruction in Recurrent Ovarian Cancer:  An Updated Series
Drs. Dennis S. Chi, Bhavana Pothuri, Ami Vaidya , Richard R. Barakat,
Carol Adhahanian, Ennapadam Venkatraman, William J. Hoskins
Memorial Sloan-Kettering Medical Center
New York, New York

Introduction:   Intestinal obstruction is one of the most frequent sequelae of recurrent ovarian cancer. Previous series have reported median survivals of 4-6 months in patients who undergo surgery for bowel obstruction due to recurrent disease.  The purpose of this study was to analyze a contemporary series of patients to determine if outcomes have changed in patients undergoing palliative surgery. 

Methods: We performed a retrospective review of all patients undergoing surgery for intestinal obstruction due to recurrent ovarian cancer from 1994-1999.

Results: During the study period, 69 operations were performed on 64 patients. The mean age at the time of obstruction was 57.3 years (range= 28.6-79.3 years).  The mean time in months from original diagnosis of ovarian cancer to obstruction was 2.8 years (range= 0.3-8.6 years).  Surgical correction, defined as intestinal surgery performed for relief of obstruction, was possible in 57/69 patients (83%). Eleven of the 12 patients underwent exploration and had gastrostomy tube placement only, because no definitive surgical correction was possible. Successful palliation, defined as tolerating a regular or low residue diet at least 60 days post-operatively, was noted in 37/50 patients (74%).  The overall rate of successful palliation in all patients who underwent exploration was 37/62 (60%).  There was one death from a pulmonary embolus and one from peritonitis. Two other deaths occurred due to progression of disease within one month of surgery for an overall peri-operative mortality rate of 6%. Forty seven out of 69 (68%) patients received post-operative chemotherapy. The median survival of the entire cohort was 8 months. If surgery resulted in successful palliation, the median survival was 10 months versus 4 months for all other patients.

Conclusions:  Our current series reveals that the majority of patients undergoing surgery have successful palliation, and receive further chemotherapy.  The median survival of patients with successful palliation is 10 months, longer than previously reported.  This is most likely due to the availability of newer, improved chemotherapeutic agents and /or  improved patient selection for surgery.