ArticleWorld journal of surgical oncology2025
Small bowel obstruction and ovarian cancer: insights from a propensity-score matched study in patients with and without hyperthermic intraperitoneal chemotherapy after cytoreductive surgery.
Article in World journal of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
backgroundSmall bowel obstruction (SBO) affects ~ 30% of ovarian cancer (OC) patients, leading to readmission, debilitating symptoms, and death within one year. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) effectively controls peritoneal disease. We investigated primary CRS/HIPEC's impact on SBO and obstruction-free survival (OFS) in OC patients.
methodsA retrospective single-center cohort study of stage III/IV OC patients treated with primary optimal CRS (2014-2022) was performed. Patients who underwent upfront CRS/HIPEC vs. CRS only were matched for histology, age (> 65 years), extent of disease, FIGO stage, and surgery year, using a propensity scored full matching algorithm. CRS/HIPEC effect on OFS was determined using a weighted cox-regression model. OFS was measured from surgery to SBO/death.
resultsOverall, 102 patients were included, 29 underwent CRS/HIPEC and 73 CRS only. CRS/HIPEC had higher median number of upper abdominal procedures (4 [IQR: 3-5] vs. 1 [IQR: 0-4], p < 0.01). Postoperative major morbidity was similar (p = 0.62). After a median follow-up of 88.8 months, SBO occurred in 24.1% (n = 7) CRS/HIPEC vs. 42.0% (n = 34) CRS only (p = 0.12). Most SBOs were partial (CRS/HIPEC: 71.4%, CRS: 55.9%) and managed conservatively (CRS/HIPEC: 71.4%, CRS: 67.6%). Median OFS was 42.9 vs. 20.0 months (HR: 0.50 [95% CI 0.27-0.93], p = 0.028). One-year survival after initial SBO was 85.7% vs. 44.7%, respectively (HR: 0.79 [95% CI 0.39-1.61], p = 0.512).
conclusionsSBO after upfront CRS/HIPEC for OC occurred less frequently, was delayed, and had lower 1-year mortality compared to CRS alone. CRS, which includes upper abdominal exploration/surgery, coupled with HIPEC could enhance long-term peritoneal disease control in OC patients.
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