REACT bowel REcovery after CyToreductive surgery for advanced ovarian cancer

Objective

This study aims to assess the prevalence of low anterior resection syndrome (LARS) in patients undergoing cytoreductive surgery for primary or recurrent ovarian cancer. Additionally, it identifies risk factors for bowel dysfunction, assesses urinary and sexual symptoms, examines the impact of diverting ostomy on quality-of-life.

Methods

Validated questionnaires assessed postoperative bowel (LARS score, KESS), urinary (BFLUTS), and sexual (FSFI) dysfunction, as well as quality-of-life in ostomized patients (STOMA-QoL). Logistic regression analyses identified predictive factors.

Results

Among 430 patients assessed for bowel dysfunction 8.8 % reported LARS (5.3 % minor, 3.5 % major), while chronic constipation was more prevalent (48.4 %, including 13.5 % severe cases). Low bowel resection (≤5 cm) was the strongest predictor of both minor and major LARS (p < 0.001) and minor and major constipation (p = 0.009 and p = 0.019). Severe constipation was additionally associated with lumboaortic lymphadenectomy (OR 1.937, p = 0.031) and disease recurrence (OR 2.095, p = 0.021). Urinary dysfunction affected 35.2 % of patients, impacting quality-of-life in 8.9 %. Sexual dysfunction was highly prevalent (68 %). Among ostomized patients, quality-of-life improved over time (p = 0.001) but remained suboptimal.

Conclusions

This study highlights the significant burden of postoperative bowel dysfunction in ovarian cancer patients undergoing cytoreductive surgery. While major LARS was uncommon, chronic constipation emerged as a more prominent issue. Low resection height (≤5 cm) was the strongest predictor of dysfunction, with additional associations identified for lymphadenectomy and disease recurrence. High rates of urinary and sexual dysfunction highlight the need for a multidisciplinary approach to optimize survivorship care.