Comparison of the efficacy of low anterior resection with primary anastomosis and Hartmann's procedure in advanced primary or recurrent epithelial ovarian cancer

Abstract

Objective: We compared the efficacy between low anterior resection with primary anastomosis (LARA) and Hartmann's procedure (HP) in advanced primary or recurrent epithelial ovarian cancer (EOC).

Study design: We reviewed medical records of 61 patients with advanced primary or recurrent EOC who underwent LARA or HP between January 1998 and August 2008. In 37 patients with primary FIGO stage III-IV EOC, 22 and 15 received LARA and HP, whereas 10 and 14 underwent LARA and HP in 24 patients with recurrent EOC.

Results: Postoperative complications (recto-vaginal fistula, leakage at the anastomotic site, postoperative ileus for ≥ 7 days, wound dehiscence, angina pectoris, acute renal failure, febrile illness, reoperation within 30 days and postoperative death), surgical outcomes (time of operation, estimated blood loss, transfusion, postoperative hospitalization and time to normal diet) were not different between LARA and HP. Progression-free survival (median, 20 vs. 17 months) and overall survivals (median, 70 vs. 36 months) in advanced primary EOC, and surgery-specific survival (median, 32 vs. 17 months) and overall survivals (median, 52 vs. 61 months) in recurrent EOC were also not different between LARA and HP (p>0.05). Moreover, the recto-sigmoid obstruction after LARA was developed in 9.1% in advanced primary EOC and 10% in recurrent EOC, and the stoma-free rates were high in LARA (90.9% in advanced primary EOC; 90% in recurrent EOC).

Conclusions: LARA may be an optimal procedure for bowel surgery without differences in postoperative complication, surgical outcomes and survival when compared with Hartmann's procedure in advanced primary or recurrent EOC. Furthermore, the high stoma-free rate after LARA can improve postoperative quality of life by avoiding the permanent stoma formation.