Rectosigmoidectomy versus pelvic peritonectomy in the management of seromuscular involvement of superficial rectal wall tumors in advanced-stage ovarian cancer at complete interval cytoreductive surgery.

OBJECTIVE

To compare the efficacy of pelvic peritonectomy (PP) versus pelvic peritonectomy with rectosigmoid resection (PP + RSR) in managing advanced ovarian cancer (AOC) with seromuscular involvement of the rectosigmoid colon during complete interval cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS

This retrospective study included 161 patients with FIGO stage III-IV ovarian cancer who underwent either PP or PP + RSR at Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain, from January 2008 to December 2024. Propensity score matching was utilized to minimize selection biases. Surgical outcomes, including pelvic recurrence rates, disease-free survival (DFS), overall survival (OS), and postoperative complications, were analyzed.

RESULTS

After propensity score matching, 35 patients were analyzed for each group (PP + RSR and PP). No significant differences were observed in pelvic recurrence rates, despite increased recurrences in the pelvic peritonectomy group (86% vs. 68.6%, p = 0.075), nor in survival outcomes (Disease-free survival; Hazard Ratio (HR) = 1.03, 95% confidence interval (CI) 0.55-1.90, p = 0.94 and overall survival HR = 1.07, 95% CI 0.59-1.94, p = 0.816). However, the PP + RSR group experienced longer hospital stays (median 7 days [IQR 6-8] vs.11 days [IQR 8-13], p < 0.001) and higher rates of severe complications (28.6% vs. 5.8%, p = 0.004) and re-operations (1 (1.5%) vs. 5 (14.7%), p = 0.035).

CONCLUSIONS

In this cohort, no statistically significant differences were observed in disease-free survival and overall survival between the surgical approaches after multivariable and propensity score-weighted adjustment. However, due to the limited sample size and wide confidence intervals, these findings should be interpreted with caution. Furthermore, pelvic peritonectomy was associated with reduced surgical morbidity.