Surgical outcomes of rectosigmoid colon resection versus rectosigmoid wall stripping for superficial rectal wall tumors at cytoreductions for advanced ovarian cancer.

Objective: This study aimed to evaluate surgical outcomes of rectosigmoid resection versus rectosigmoid wall stripping for superficial tumor involvement during cytoreductive surgery for advanced ovarian cancer.

Methods: This retrospective study included patients with the International Federation of Gynecology and Obstetrics stage III to IV ovarian cancer who underwent rectosigmoid resection or rectosigmoid wall stripping during primary or interval cytoreductive surgery between January 2021 and January 2024. Inverse probability of treatment weighting was used to balance baseline characteristics. Perioperative and oncologic outcomes were compared using appropriate statistical tests, including χ², Fisher exact, Wilcoxon rank-sum, and Z-tests.

Results: A total of 322 patients (rectosigmoid resection, n = 182; rectosigmoid wall stripping, n = 140) were included. A transition from rectosigmoid resection to rectosigmoid wall stripping began in mid-2022, resulting in an 83% reduction in rectosigmoid resection and a 900% increase in rectosigmoid wall stripping by late 2023. Rectosigmoid wall stripping was associated with shorter operation time (310 vs 400.8 minutes, p < .0001), lower blood loss (median, 489.4 vs 700 mL, p < .0001), fewer transfusions (31.3% vs 54.4%, p = .0002), shorter hospital stays (median, 11 vs 12 days, p = .0001), fewer thromboembolic events (6% vs 13.0%, p = .0356), and faster chemotherapy initiation (20 vs 22 days, p = .0002). Complete cytoreduction rates (72.6% vs 79.0%, p = .5152) and 6-month mortality (2.3% vs 1.7%, p = .6795) were similar. The rectosigmoid resection group showed a trend toward higher rates of bowel perforation (3.0% vs 0.8%) and fistula formation (2.0% vs 1.0%), although these differences were not statistically significant.

Conclusions: For superficial and limited rectal serosal involvement, rectosigmoid wall stripping achieved macroscopic tumor clearance while reducing perioperative complications compared with rectosigmoid resection, which should be reserved for deeper or more extensive disease. Six-month follow-up showed comparable mortality rates between the 2 groups. Long-term and large-scale data are needed to ensure comparable oncologic safety.