Diverting ileostomy during primary cytoreductive surgery for ovarian cancer: Associated factors and postoperative outcomes

Objectives: To investigate the associated factors and postoperative outcomes of diverting loop ileostomy (DI) at the time of primary cytoreductive surgery (CRS) for ovarian cancer. Methods: All patients with stage II–IV ovarian, tubal, or peritoneal carcinoma who underwent colon resection during primary CRS at our institution from January 2005 to December 2013 were identified. Demographics and clinical data were collected. Statistical analysis was performed using SPSS v22 software. Results: Among 331 patients, 231 (70%) had stage III disease and 292 (88.2%) had high-grade serous histology. Median age was 61 years (range 26–91 years) and median serum albumin was 4.1 g/dL (2.5–4.9 g/dL). Optimal debulking was achieved in 91% of cases. One bowel resection was performed in 72.8% of patients and more than 1 bowel resection was performed in 27.2%. Eighty-five percent underwent rectosigmoid (RS) resection; 35.6% underwent other colon resection. Median length of stay (LOS) was 11 days (3–69 days). Eighty patients (24.2%) had 1 or more grade 3–4 postoperative complication. Sixty-day readmission rate was 23%. Median time from surgery to adjuvant chemotherapy was 40 days. Forty-four (13.3%) patients underwent DI. There were no significant differences in age, body mass index, comorbidity index, smoking status, serum albumin, attending surgeon, or rate of intraoperative complications between patients who underwent DI and those who did not (non-DI). Diabetes (13.6% vs 4.2%; OR 3.41, 95% CI 1.12–10.39; P =.031), operative time (8.1 vs 6.2 hours; OR 1.23, 95% CI 1.04–1.44; P =.013), and length of RS resection (20.5 vs 15.5 cm; OR 1.04, 95% CI 1.01–1.08; P =.005) were significant predictors of DI on multivariate analysis. There was no significant difference in 30-day complications, hospital LOS, readmission rate, or interval to adjuvant chemotherapy between patients with DI and those without (non-DI). Median follow-up time was 52.6 months. Between the DI and non-DI groups, there was no difference in median progression-free (17.9 vs 18.6 mo, P =.881) or overall survival (48.7 vs 63.8 mo, P =.249). Conclusions: In patients undergoing primary cytoreductive surgery, those with diabetes, longer operative time, and greater length of rectosigmoid resection more commonly underwent DI. DI does not appear to compromise postoperative outcomes or long-term survival.