abstract: Incidence of and Risk Factors for Postoperative Ileus in Women Undergoing Primary Staging and Debulking for Epithelial Ovarian Carcinoma

Incidence of and Risk Factors for Postoperative Ileus in Women Undergoing Primary Staging and Debulking for Epithelial Ovarian Carcinoma

Objective
Thorough primary cytoreduction for epithelial ovarian carcinoma (EOC) improves survival. The incidence of postoperative ileus (POI) in these patients may be underreported because of varying POI definitions and the evolving, increasingly complex contemporary surgical approach to EOC. We sought to determine the current incidence of POI and its risk factors in women undergoing debulking and staging for EOC.

Methods
We retrospectively identified the records of women who underwent primary staging and cytoreduction for EOC between 2003 and 2008. POI was defined as a surgeon's diagnosis of POI, return to nothing-by-mouth status, or reinsertion of a nasogastric tube. Perioperative patient characteristics and process-of-care variables were analyzed. Univariate analyses were used to identify POI risk factors; variables withP≤.20 were included in multivariate analysis.

Results
Among 587 women identified, the overall incidence of POI was 30.3% (25.9% without bowel resection, 38.5% with bowel resection;P = .002). Preoperative thrombocytosis, involvement of bowel mesentery with carcinoma, and perioperative red blood cell transfusion were independently associated with increased POI. Postoperative ibuprofen use was associated with decreased POI risk. Women with POI had a longer length of stay (median, 11 vs 6 days) and increased time to recovery of the upper (7.5 vs 4 days) and lower (4 vs 3 days) gastrointestinal tract (P < .001 for each).

Conclusions
The rate of POI is substantial among women undergoing staging and cytoreduction for EOC and is associated with increased length of stay. Modifiable risk factors may include transfusion and postoperative ibuprofen use. Alternative interventions to decrease POI are needed.

Highlights

► In this study, 30% of women undergoing EOC debulking had postoperative ileus (POI).
► Transfusion was associated with increased POI in a dose–response fashion.
► Postoperative use of ibuprofen decreased the incidence of POI.

abstract: Clinical predictors of (Avastin) bevacizumab-associated gastrointestinal perforation

Abstract

OBJECTIVES: Bevacizumab is a generally well-tolerated drug, but bevacizumab-associated gastrointestinal perforations (BAP) occur in 0 to 15% of patients with ovarian carcinoma. Our goal was to evaluate the clinical predictors of BAP in order to identify factors, which may preclude patients from receiving treatment.
METHODS: We conducted a review of patients with recurrent epithelial ovarian carcinoma treated with bevacizumab between 2006 and 2009. Demographic and treatment data were collected for statistical analysis.
RESULTS: Eighty-two patients were identified; perforation occurred in 8 (9.76%). Among patients with perforation, a significantly higher incidence of prior bowel surgeries (p=0.0008) and prior bowel obstruction or ileus.
CONCLUSIONS: Predicting BAP remains a challenge. Bowel obstruction or ileus appears to be associated with increased risk of BAP.

abstract: Imaging of the gastrointestinal complications of systemic chemotherapy

Abstract:

Gastrointestinal complications of chemotherapy may be serious and potentially life-threatening. Familiarity with and awareness of the potential complications associated with various chemotherapeutic agents/regimens is paramount to enable accurate and timely diagnosis. In this article we review the radiological manifestations of the most notable gastrointestinal complications associated with chemotherapeutic administration.

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Introduction

Neutropenic enterocolitis

Pseudomembranous colitis

Ulceration

Perforation

GI haemorrhage

Ileus

Obstruction

Mesenteric infarction

Conclusion

Figure 1. A 70-year-old woman on day 10 of idorubicin and cytosine arabinoside chemotherapy for acute myeloid leukaemia developed vomiting, abdominal pain, loose bloody stool, and was profoundly neutropenic. Intravenous contrast-enhanced CT demonstrates diffuse colonic mural thickening (black arrow), with surrounding mesenteric stranding (white curved arrow) and ascites (black curved arrow). The distribution is pan-colonic. This constellation of clinical and radiological findings is highly suggestive of neutropenic enterocolitis.

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