The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery Christoph Grimm a,b, ⁎ ,1 , Philipp Harter a , Pier F. Alesina c , Sonia Prader a , Stephanie Schneider a , Beyhan Ataseven a , Beate Meier c , Violetta Brunkhorst d , Jakob Hinrichs c , Christian Kurzeder a , Florian Heitz a , Annett Kahl a , Alexander Traut a , Harald T. Groeben d , Martin Walz c , Andreas du Bois a a Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany b Department of General Gynecology and Gynecologic Oncology, Gynecologic Cancer Center, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria c Department of Visceral Surgery, Kliniken Essen-Mitte, Essen, Germany d Department of Anesthesiology and Intensive Care, Kliniken Essen-Mitte, Essen, Germany HIGHLIGHTS • Anastomotic leakage (AL) rate after debulking surgery with bowel resection was 6.9%. • Rectosigmoid resection seems to be associated with the highest rate of AL. • Multiple bowel resections led to a slight but not significant increase in AL rate. • We were not able to identify predictive factors for AL. abstract article info Article history: Received 19 March 2017 Received in revised form 3 June 2017 Accepted 6 June 2017 Available online xxxx Objective. To identify risk factors for anastomotic leakage (AL) in patients undergoing primary advanced ovar- ian cancer surgery and to evaluate the prognostic implication of AL on overall survival in these patients. Methods. We analyzed our institutional database for primary EOC and included all consecutive patients treat- ed by debulking surgery including any type of full circumferential bowel resection beyond appendectomy be- tween 1999 and 2015. We performed logistic regression models to identify risk factors for AL and log-rank tests and Cox proportional hazards models to evaluate the association between AL and survival. Results. AL occurred in 36/800 (4.5%; 95% confidence interval [3%–6%]) of all patients with advanced ovarian cancer and 36/518 (6.9% [5%–9%]) patients undergoing bowel resection during debulking surgery. One hundred fifty-six (30.1%) patients had multiple bowel resections. In these patients, AL rate per patient was only slightly higher (9.0% [5%–13%]) than in patients with rectosigmoid resection only (6.9% [4%–10%]), despite the higher number of anastomosis. No independent predictive factors for AL were identified. AL was independently associ- ated with shortened overall survival (HR 1.9 [1.2–3.4], p = 0.01). Conclusion. In the present study, no predictive pre- and/or intraoperative risk factors for AL were identified. AL rate was mainly influenced by rectosigmoid resection and only marginally increased by additional bowel resections. © 2017 Elsevier Inc. All rights reserved. Keywords: Anastomotic leakage Bowel resection Debulking surgery Epithelial ovarian cancer 1. Introduction Surgical treatment is, next to platinum-based chemotherapy, the crucial treatment modality of advanced epithelial ovarian cancer (EOC) [1]. Postoperative residual disease is the most important prog- nostic parameter for patients with EOC and is accessible for therapeutic modification. The goal of debulking surgery is to achieve no macroscop- ic residual disease at the end of surgery [1–4]. In advanced EOC, it is fre- quently necessary to perform radical surgery including upper Gynecologic Oncology xxx (2017) xxx–xxx ⁎ Corresponding author at: Department of General Gynecology and Gynecologic Oncology, Gynecologic Cancer Center, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria. E-mail address: christoph.grimm@muv.ac.at (C. Grimm). 1 This work is one of the thesis papers of his ESGO fellowship program which he com- pleted in Essen, Germany. YGYNO-976771; No. of pages: 6; 4C: http://dx.doi.org/10.1016/j.ygyno.2017.06.007 0090-8258/© 2017 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Please cite this article as: C. Grimm, et al., The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery, Gynecol Oncol (2017), http://dx.doi.org/10.1016/j.ygyno.2017.06.007