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REVIEW article

Front. Surg.
Sec. Obstetrics and Gynecological Surgery
Volume 11 - 2024 | doi: 10.3389/fsurg.2024.1434730
This article is part of the Research Topic Update on the Diagnosis and Surgical Treatment of Gynecological Tumors View all 4 articles

Surgical management of anastomotic leakage related to ovarian cancer surgery: a narrative review

Provisionally accepted
Stefano Restaino Stefano Restaino 1,2Sofia Schierano Sofia Schierano 2Martina Arcieri Martina Arcieri 2*Barbara Costantini Barbara Costantini 3Alice Poli Alice Poli 2Sara Pregnolato Sara Pregnolato 2Giovanni Terrosu Giovanni Terrosu 4Sergio Calandra Sergio Calandra 4Marco Petrillo Marco Petrillo 5Giulia Pellecchia Giulia Pellecchia 2Alessandro Lucidi Alessandro Lucidi 6Marko Klaric Marko Klaric 7Lorenza Driul Lorenza Driul 2Vito Chiantera Vito Chiantera 8Alfredo Ercoli Alfredo Ercoli 9Cristina Taliento Cristina Taliento 10,11Francesco Fanfani Francesco Fanfani 3Anna Fagotti Anna Fagotti 3Giovanni Scambia Giovanni Scambia 3Giuseppe Vizzielli Giuseppe Vizzielli 2
  • 1 PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, Sassari, Italy, Sassari, Italy
  • 2 Department of Medical Area (DMED), Clinic of Obstetrics and Gynecology Unit, Santa Maria della Misericordia Hospital, Azienda Sanitaria Friuli Centrale, 33100 Udine, Italy
  • 3 Department of Women's Health, Children's Health and Public Health, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
  • 4 Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
  • 5 Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
  • 6 Dipartimento di Ostetricia e Ginecologia, Università G. d'Annunzio di Chieti e Pescara, Chieti, Italy
  • 7 Clinic for Gynecology and Obstetrics, Clinical Hospital Centre Rijeka, Rijeka, Croatia
  • 8 Dipartimento di Promozione della Salute, Medicina Materno-Infantile, Interna e Specialistica di Eccellenza G. D'Alessandro, Università degli Studi di Palermo, Palermo, Italy
  • 9 Divisione di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
  • 10 University Hospital of Ferrara, Ferrara, Italy
  • 11 Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium

The final, formatted version of the article will be published soon.

    This narrative review describes the state of the art in the management of anastomotic leakage in ovarian cancer. Multiple surgical procedures, including bowel resection, are often required to achieve "optimal" cytoreduction in locally advanced ovarian cancer. Intestinal anastomosis is currently the most common way to restore bowel continuity. However, in some patients, a temporary protective stoma is indicated to prevent anastomotic leakage. This is an important issue to improve surgical outcomes and until recently there has been a lack of objective data to clarify the risk factors for anastomotic leakage. This review describes the risk factors for AL associated with surgery and compares the results of recent studies. We also review the current indications for placement of a protective ileostomy and treatment options for conservative management of AL. We present two examples of practical clinical AL risk calculators, in addition to the most assessed AL risk factor. To date, the decision-making processes that lead surgeons to perform a protective ileostomy are quite heterogeneous and based on the personal experience of the surgeon, mainly depending on individual training. Three different management options after colorectal anastomosis in OC are described: conservative management, diversion ileostomy and ghost ileostomy.

    Keywords: ovarian cancer, Debulking surgery, Anastomosis leakage, stoma, Rectosigmoid resection, Risk factors

    Received: 18 May 2024; Accepted: 29 Aug 2024.

    Copyright: © 2024 Restaino, Schierano, Arcieri, Costantini, Poli, Pregnolato, Terrosu, Calandra, Petrillo, Pellecchia, Lucidi, Klaric, Driul, Chiantera, Ercoli, Taliento, Fanfani, Fagotti, Scambia and Vizzielli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Martina Arcieri, Department of Medical Area (DMED), Clinic of Obstetrics and Gynecology Unit, Santa Maria della Misericordia Hospital, Azienda Sanitaria Friuli Centrale, 33100 Udine, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.