OBJECTIVE Anastomotic leak remains the main concern after colorectal anastomosis in ovarian cancer. Our objective was to compare the use of three different management approaches after colorectal resection and anastomosis in patients with ovarian cancer. METHODS Between January 2010 and June 2018, a total of 133 patients with International Federation of Gynecology and Obstetrics (FIGO) stage II-IV ovarian cancer who underwent colorectal resection and anastomosis were included. According to the approach followed after colorectal anastomosis and during the post-operative period, patients were stratified into three groups: conservative management and observation, diverting ileostomy, or ghost ileostomy technique. Univariate analyses were performed for quantitative variables by applying Student's t test or Mann-Whitney U test and for qualitative variables by using the χ2 test (or Fisher's test according to the sample size). RESULTS A total of 145 patients underwent colorectal resection during cytoreduction for FIGO stage II-IV ovarian cancer. Twelve patients were excluded because a colostomy was required. Thus, 133 patients were included in the final analysis. Modified posterior pelvic exenteration was performed in 121 (91%) patients and recto-sigmoid resection in 12 (9%) patients with relapse. The approach after anastomosis was wait-and-see in 72 patients (54.1%), diverting ileostomy in 19 patients (14.4%), and ghost ileostomy in 42 patients (31.5%). There were no differences in diagnosis, age, body mass index, ECOG (Eastern Cooperative Oncology Group), histology, tumor grade, FIGO stage, or type of surgery between the groups. No differences were found regarding the anastomosis leak related factors or the rate of anastomotic leak between the three groups (5.6% vs 5.3% vs 4.8%; p=0.98). Two patients died because of the anastomotic leak in the wait-and-see group, and none died in the diverting ileostomy or ghost ileostomy group. In the diverting ileostomy group, a higher number of patients had complications compared with the ghost ileostomy group (78.9% vs 7.1%; p<0.01). Four patients (21.1%) developed dehydration due to high output stoma (>1500 mL) causing electrolyte imbalance in the diverting ileostomy group, and one patient (2.4%) in the ghost ileostomy group (p=0.03). The stoma reversal rate was 73.7% for the diverting ileostomy group and 100% for the ghost ileostomy group. CONCLUSIONS There were no differences found in the rate of anastomotic leak among the three groups of patients. The use of ghost ileostomy avoids the drawbacks of diverting ileostomy and seems to have advantages over routine diverting ileostomy and wait-and-see approaches for ovarian cancer patients undergoing colorectal anastomosis. Rates of stoma reversal are lower after diverting ileostomy when compared with ghost ileostomy.

中文翻译：

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卵巢癌结直肠吻合术后三种不同处理方法的比较研究：保守处理，改行回肠造口术和幽门回肠造口术。

目的卵巢癌结直肠吻合术后吻合口漏仍是主要问题。我们的目标是比较卵巢癌患者在结直肠切除和吻合后使用三种不同的治疗方法。方法在2010年1月至2018年6月期间，共计133例接受了结直肠切除和吻合术的国际妇产科联合会（FIGO）II-IV期卵巢癌患者。根据大肠吻合术后和术后的方法，将患者分为三组：保守治疗和观察，分流回肠造口术或幽门回肠造口术。通过应用Student's对变量进行单变量分析 st检验或Mann-Whitney U检验，并使用χ2检验（或根据样本量进行Fisher检验）进行定性变量。结果在FIGO II-IV期卵巢癌的细胞减少过程中，共有145例患者接受了大肠切除术。因为需要结肠造口术，所以排除了十二名患者。因此，最终分析包括133名患者。121例（91％）患者进行了改良的盆腔后入路手术，12例（9％）复发患者进行了直肠乙状结肠切除术。吻合术后的方法是72例（54.1％）观望，19例（14.4％）改行回肠造口术，42例（31.5％）进行回肠造口术。两组之间在诊断，年龄，体重指数，ECOG（东部合作肿瘤小组），组织学，肿瘤分级，FIGO分期或手术类型方面无差异。三组之间的吻合口漏相关因素或吻合口漏率没有差异（5.6％vs 5.3％vs 4.8％； p = 0.98）。在观望组中有2例患者因吻合口漏而死亡，而在分流回肠造口术或幻影回肠造口术组中无一例死亡。在分流回肠造口术组中，与假性回肠造口术组相比，有更多的患者发生并发症（78.9％vs 7.1％； p <0.01）。回肠造口术组中有4例（21.1％）由于高输出气孔（> 1500 mL）导致电解质失衡而出现脱水，而幻影回肠造口组中有1例（2.4％）（p = 0.03）。转向回肠造口术组的造口逆转率为73.7％，幽灵回肠造口术组为100％。结论三组患者的吻合口漏率没有差异。幽灵回肠造口术避免了回肠造口术的弊端，并且似乎比常规的分流回肠造口术和接受结直肠吻合术的卵巢癌患者更具优势。与幽灵回肠造口术相比，分流回肠造口术后的造口逆转率更低。