Pelvic peritonectomy versus rectosigmoid resection in advanced epithelial ovarian cancer with Douglas pouch involvement: a systematic review and meta-analysis
To compare the oncologic outcomes in patients with advanced epithelial ovarian cancer and Douglas pouch involvement who underwent pelvic peritonectomy vs rectosigmoid resection as part of cytoreductive surgery. A systematic literature review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist. MEDLINE (through Ovid), Embase, and Cochrane Central Register of Controlled Trials were searched from inception until March 2024. We included studies with 2 arms of intervention comparing pelvic peritonectomy and rectosigmoid resection in patients diagnosed with advanced epithelial ovarian cancer (International Federation of Gynecology and Obstetrics 2014 stage IIB-IVB). Randomized controlled trials and prospective and retrospective observational studies were considered. The protocol was registered in PROSPERO (CRD42024535681). The search identified 821 articles; 598 studies were considered potentially eligible after removing duplicates, and 4 met the selection criteria, including a total of 623 patients. All 4 studies were retrospective. There was no statistically significant difference between patients undergoing pelvic peritonectomy compared to rectosigmoid resection in terms of overall recurrences (OR 0.99, 95% CI 0.53 to 1.83, I The comparison between pelvic peritonectomy and rectosigmoid resection for the treatment of Douglas pouch carcinomatosis in advanced ovarian cancer revealed no significant differences in overall and pelvic recurrence rates. Disease-free and overall survival were comparable between the 2 surgical techniques. However, pelvic peritonectomy was associated with shorter surgeries, reduced stoma formation, shorter hospital stay, and lower blood loss and transfusion requirements.
