SpringerLink
Log in

Comparison of Outcomes in Bowel Resections by Gynecologic Oncologists Versus General Surgeons During Maximal Cytoreductive Surgery for Advanced Ovarian Cancer: Gynecologic Oncology Research Investigators Collaboration Study (GORILLA-3006)

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This report describes the oncologic outcomes for patients with advanced ovarian cancer who had bowel surgery performed by gynecologic oncologists (GOs) and compares the outcomes with those for bowel surgery performed by general surgeons (GSs) during maximal cytoreductive surgery.

Methods

Patients from six academic institutions who had FIGO stage III or IV ovarian cancer and underwent any bowel surgeries during maximal cytoreductive surgery were eligible for the study. The patients were divided into two groups according to whether bowel surgery was performed by a GO or a GS. In both groups, the GOs were mainly involved in extra bowel debulking procedures. Perioperative and survival outcomes were compared between the two groups.

Results

The 761 patients in this study included 113 patients who underwent bowel surgery by a GO and 648 who had bowel surgery by a GS. No discernible differences were observed in age, American Society of Anesthesiology (ASA) score, FIGO stage, histologic type, timing of cytoreductive surgery (primary or interval debulking surgery), or complications between the two groups. The GO group exhibited a shorter operation time than the GS group. Kaplan–Meier analysis showed no survival differences between the two groups. In the Cox analysis, non-serous cell types and gross residual diseases were associated with adverse effects on overall survival. However, performance of bowel surgery by a GO did not have an impact on survival.

Conclusion

Performance of bowel surgery by a GO during maximal cytoreductive surgery is both feasible and safe. These results should be reflected in the training system for GOs regarding bowel surgery, and further research is needed to confirm that GOs can play a more leading role in performing extra-uterine procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

References

  1. Chang SJ, Bristow RE, Chi DS, Cliby WA. Role of aggressive surgical cytoreduction in advanced ovarian cancer. J Gynecol Oncol. 2015;26:336–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Chang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol. 2013;130:493–8.

    Article  PubMed  Google Scholar 

  3. Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998;69:103–8.

    Article  CAS  PubMed  Google Scholar 

  4. Dottino JA, He W, Sun CC, et al. National trends in bowel and upper abdominal procedures in ovarian cancer surgery. Int J Gynecol Cancer. 2020;30:1195–202.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ye S, Wang Y, Chen L, Wu X, Yang H, **ang L. The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients. BMC Surg. 2022;22:81.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Searle G, Pounds R, Phillips A, et al. Prolonged interruption of chemotherapy in patients undergoing delayed debulking surgery for advanced high grade serous ovarian cancer is associated with a worse prognosis. Gynecol Oncol. 2020;158:54–8.

    Article  CAS  PubMed  Google Scholar 

  7. Arora V, Somashekhar SP. Essential surgical skills for a gynecologic oncologist. Int J Gynecol Obstet. 2018;143:118–30.

    Article  Google Scholar 

  8. Nishikimi K, Tate S, Kato K, Matsuoka A, Shozu M. Well-trained gynecologic oncologists can perform bowel resection and upper abdominal surgery safely. J Gynecol Oncol. 2020;31(1):e3.

    Article  PubMed  Google Scholar 

  9. Subspecialist guideline for gynecologic oncologist of Korean Society of Gynecologic Oncology. KSGO

  10. Aletti GD, Dowdy SC, Podratz KC, Cliby WA. Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obstet Gynecol. 2007;197(6):676.

    Article  Google Scholar 

  11. Tozzi R, Valenti G, Vinti D, Campanile RG, Cristaldi M, Ferrari F. Rectosigmoid resection during visceral-peritoneal debulking (VPD) in patients with stage IIIC-IV ovarian cancer: morbidity of gynecologic oncology vs. colorectal team. J Gynecol Oncol. 2021;32:e42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lim MC, Won YJ, Ko MJ, et al. Incidence of cervical, endometrial, and ovarian cancer in Korea during 1999–2015. J Gynecol Oncol. 2019;30:e38.

    Article  PubMed  Google Scholar 

  13. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.

    Article  PubMed  Google Scholar 

  14. Ang C, Chan KK, Bryant A, Naik R, Dickinson HO. Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 2011;2011:Cd007697.

    Google Scholar 

  15. Mulligan K, Corry E, Donohoe F, et al. Multidisciplinary surgical approach to increase survival for advanced ovarian cancer in a tertiary gynaecological oncology centre. Ann Surg Oncol. 2024;31:460–72.

    Article  PubMed  Google Scholar 

  16. Eisenkop SM, Spirtos NM. What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer? Gynecol Oncol. 2001;82:489–97.

    Article  CAS  PubMed  Google Scholar 

  17. Tewari KS. Advanced cytoreductive surgery workshop report. Int J Gynecol Cancer. 2012;22:1604–10.

    Article  PubMed  Google Scholar 

  18. Eisenkop SM, Spirtos NM, Montag TW, Nalick RH, Wang HJ. The impact of subspecialty training on the management of advanced ovarian cancer. Gynecol Oncol. 1992;47:203–9.

    Article  CAS  PubMed  Google Scholar 

  19. Huddart D, Rajkumar S, Kolomainen D, Mehra G, Nath R, Sayasneh A. Gynae-oncology surgeons’ preparedness to undertake colorectal procedures during cytoreductive surgery for ovarian cancer: a cross sectional survey. J Clin Med. 2022;11(21):6233.

    Google Scholar 

  20. Son JH, Kim J, Shim J, et al. Comparison of posterior rectal dissection techniques during rectosigmoid colon resection as part of cytoreductive surgery in patients with epithelial ovarian cancer: close rectal dissection versus total mesorectal excision. Gynecol Oncol. 2019;153:362–7.

    Article  PubMed  Google Scholar 

  21. Derlatka P, Sienko J, Grabowska-Derlatka L, et al. Results of optimal debulking surgery with bowel resection in patients with advanced ovarian cancer. World J Surg Oncol. 2016;14:58.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Obermair A, Hagenauer S, Tamandl D, et al. Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer. Gynecol Oncol. 2001;83:115–20.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, College of Medicine Chung-Ang University, Seoul, Republic of Korea

    Myeong-Seon Kim MD, PhD

  2. Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea

    A. ** Lee MD, Seung-Hyuk Shim MD, PhD. & Eun Bi Jang MD

  3. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Nam Kyeong Kim MD, Min Kyung Kim MD & Dong Hoon Suh MD

  4. Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea

    Jeeyeon Kim MD, Joo-Hyuk Son MD, Tae-Wook Kong MD & Suk-Joon Chang MD, PhD

  5. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Dong Won Hwang MD, Soo ** Park MD & Hee Seung Kim MD, PhD

  6. Department of Obstetrics and Gynecology, Daejeon St Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea

    Ji Geun Yoo MD

  7. Department of Obstetrics and Gynecology, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Sung Jong Lee MD, PhD

  8. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Yoo-Young Lee MD, PhD

Authors
  1. Myeong-Seon Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. ** Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung-Hyuk Shim MD, PhD.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eun Bi Jang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nam Kyeong Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Min Kyung Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong Hoon Suh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeeyeon Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joo-Hyuk Son MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tae-Wook Kong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Suk-Joon Chang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Dong Won Hwang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Soo ** Park MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hee Seung Kim MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ji Geun Yoo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Sung Jong Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Yoo-Young Lee MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yoo Young Lee : Conceptualization, Methodology, Supervision, Statistical review, Writing review and editing; Myeong Seon Kim: Statistical analysis, Writing draft, editing and review ; A ** Lee: Data collection; Seung Hyuk Shim: Data collection; Eun Bi Jang: Data collection; Nam Kyeong Kim: Data collection; Min Kyung Kim Data colle ction; Dong Hoon Suh: Data collection; Jeeyeon Kim: Data collection; Joo Hyuk Son: Data collection; Tae Wook Kong: Data collection; Suk Joon Chang: Data collection; Dong Won Hwang: Data collection; Soo ** Park: Data collection; Hee Seung Kim: Data collection; Ji Geun Yoo: Data collection; Sung Jong Leeg: Data collection

Corresponding author

Correspondence to Yoo-Young Lee MD, PhD.

Ethics declarations

Disclosure

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, MS., Lee, A.J., Shim, SH. et al. Comparison of Outcomes in Bowel Resections by Gynecologic Oncologists Versus General Surgeons During Maximal Cytoreductive Surgery for Advanced Ovarian Cancer: Gynecologic Oncology Research Investigators Collaboration Study (GORILLA-3006). Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15643-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1245/s10434-024-15643-9

Keywords

Search

Navigation