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Objective <p>To identify risk factors associated with and evaluate the impact of anastomotic leakage on oncological outcomes in patients with advanced-stage (Fédération Internationale de Gynécologie et d’Obstétrique [International Federation of Gynaecology and Obstetrics], FIGO grade III–IV) high-grade serous ovarian cancer who underwent rectosigmoid resection with primary anastomosis during cytoreductive surgery.</p> Materials and methods <p>The data of 102 patients treated between September 2015 and October 2024 at two tertiary gynaecologic oncology centres were retrospectively analyzed. Demographic, clinical, intraoperative, and postoperative parameters were reviewed. Anastomotic leakage was diagnosed on the basis of clinical, radiological, or intraoperative findings. Progression-free survival (PFS) and overall survival (OS) were analysed using the Kaplan–Meier method.</p> Results <p>Rectosigmoid anastomotic leakage occurred in 9 (8.8%) patients—all of whom were surgically managed—and was not attributed to mortality. Patients with greater intraoperative blood loss, a greater number of transfused red blood cell units and lower serum albumin levels on postoperative day 1 demonstrated a significantly increased risk of anastomotic leakage. Although anastomotic leakage significantly delayed the initiation of adjuvant chemotherapy (median 39.5 days vs. 18 days), no statistically significant difference in PFS or OS was identified under the prespecified endpoint definition (time zero at completion of adjuvant chemotherapy).</p> Conclusion <p>Rectosigmoid resection with primary anastomosis can be safely performed in patients with advanced high-grade serous ovarian cancer as part of cytoreductive surgery. Intraoperative haemorrhage, the need for perioperative transfusion, and early postoperative hypoalbuminaemia are key predictors of anastomotic leakage. Anastomotic leakage was associated with delayed initiation of adjuvant chemotherapy; however, no statistically significant difference in PFS or OS was detected under the prespecified endpoint definition. However, these survival findings should be interpreted as exploratory in light of potential guarantee-time bias and unmeasured temporal changes in systemic therapy.</p>

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Anastomotic leakage after rectosigmoid resection with primary anastomosis during cytoreductive surgery for advanced high-grade serous ovarian cancer: risk factors and oncologic outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月3日

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  • Arife Ebru Tasci,
  • Fatih Kılıç,
  • Mehmet Ünsal,
  • Okan Aytekin,
  • Yeşim Özkaya Uçar,
  • Gülşah Tiryaki Güner,
  • Burak Ersak,
  • Ayşe Buran,
  • İbrahim Ethem Canbulut,
  • Caner Çakır,
  • Sevgi Koç,
  • Nurettin Boran,
  • Özlem Moraloğlu Tekin,
  • Yaprak Üstün,
  • Ahmet Taner Turan

摘要

Objective

To identify risk factors associated with and evaluate the impact of anastomotic leakage on oncological outcomes in patients with advanced-stage (Fédération Internationale de Gynécologie et d’Obstétrique [International Federation of Gynaecology and Obstetrics], FIGO grade III–IV) high-grade serous ovarian cancer who underwent rectosigmoid resection with primary anastomosis during cytoreductive surgery.

Materials and methods

The data of 102 patients treated between September 2015 and October 2024 at two tertiary gynaecologic oncology centres were retrospectively analyzed. Demographic, clinical, intraoperative, and postoperative parameters were reviewed. Anastomotic leakage was diagnosed on the basis of clinical, radiological, or intraoperative findings. Progression-free survival (PFS) and overall survival (OS) were analysed using the Kaplan–Meier method.

Results

Rectosigmoid anastomotic leakage occurred in 9 (8.8%) patients—all of whom were surgically managed—and was not attributed to mortality. Patients with greater intraoperative blood loss, a greater number of transfused red blood cell units and lower serum albumin levels on postoperative day 1 demonstrated a significantly increased risk of anastomotic leakage. Although anastomotic leakage significantly delayed the initiation of adjuvant chemotherapy (median 39.5 days vs. 18 days), no statistically significant difference in PFS or OS was identified under the prespecified endpoint definition (time zero at completion of adjuvant chemotherapy).

Conclusion

Rectosigmoid resection with primary anastomosis can be safely performed in patients with advanced high-grade serous ovarian cancer as part of cytoreductive surgery. Intraoperative haemorrhage, the need for perioperative transfusion, and early postoperative hypoalbuminaemia are key predictors of anastomotic leakage. Anastomotic leakage was associated with delayed initiation of adjuvant chemotherapy; however, no statistically significant difference in PFS or OS was detected under the prespecified endpoint definition. However, these survival findings should be interpreted as exploratory in light of potential guarantee-time bias and unmeasured temporal changes in systemic therapy.