Total colectomy as part of primary cytoreductive surgery in advanced Müllerian cancer

ObjectiveTo investigate morbidities and surgical outcomes of total colectomy conducted during primary cytoreductive surgery in advanced Müllerian cancer.MethodsThe authors reviewed the medical records of 22 patients with stage IIIC or IV advanced Müllerian cancer that underwent total colectomy at the National Cancer Center Korea between January 2003 and December 2007.ResultsTotal colectomy was performed in 22 patients, of whom 2 (9.1%) underwent prophylactic ileostomy and 1 (4.5%) permanent ileostomy. Optimal cytoreduction (residual tumor < 1 cm) was possible in 20 patients (90.9%). Median times at passage of flatus and initiation of tolerable diet were days 4 (2–10) and 6 (4–18) postoperatively, respectively. Nine postoperative morbidities, not directly related to ileo-rectal anatomosis, occurred in 7 patients (31.8%) and were successfully managed conservatively. No fistula developed during a mean follow-up of 16 months (range, 2–56). There was no surgery-related mortality. Diarrhea after total colectomy was well managed by medical treatment in most patients. Median time to recovery to previous bowel habits was 12 months (range, 6–20) in the 11 patients evaluable. Five-year progression free survival and overall survival rates were 38.6% and 74.4%, respectively.ConclusionsTotal colectomy is a feasible and safe procedure in terms of minimizing residual tumor in most patients with advanced Müllerian cancer with acceptable morbidities.