Preoperative colonoscopy in ovarian cancer: impact on surgical planning and outcomes: results from a retrospective, single-center study
Abstract
Background
Diagnosis and management of ovarian cancer remain complex due to the overlap of symptoms with other malignancies and the variability in preoperative diagnostic approaches. While histological confirmation is crucial, the role of preoperative colonoscopy in improving surgical planning and patient outcomes remains unclear.
Objective
This study aims to evaluate the impact of preoperative colonoscopy on surgical outcomes, peri-operative complications and interdisciplinary coordination in ovarian cancer patients.
Methods
A retrospective, single-center study was conducted at the University Medical Center Freiburg, including 306 patients diagnosed with malignant ovarian tumors between 2016 and 2023. Patients were stratified into two groups: those who underwent preoperative colonoscopy (n=104) and those who did not (n=202). Tumor characteristics, diagnostic findings, and surgical outcomes were compared. Primary endpoints included the detection of abnormal colonoscopic findings and their correlation with intraoperative interventions. Secondary endpoints assessed the impact of colonoscopy on macroscopic complete resection rates and peri-operative complications.
Results
Patients undergoing preoperative colonoscopy exhibited higher rates of advanced tumor stages (FIGO III/IV: 84.5% vs. 47.5%). Abnormal colonoscopic findings were observed in 38.8% of cases, yet colorectal resections were performed in only 53% of these patients. Despite a higher frequency of neoadjuvant chemotherapy in the colonoscopy group (57.3 vs. 33.7%), macroscopic complete resection rates were lower (67.0 vs. 79.2%). Sensitivity and specificity analyses indicated moderate predictive accuracy of colonoscopy for colorectal involvement (67 and 74%, respectively). In advanced ovarian cancer, preoperative colonoscopy influenced colorectal surgery decisions, with higher resection rates but minimal impact on neoadjuvant chemotherapy rates, despite moderate sensitivity and specificity.
Conclusion
While preoperative colonoscopy identified colorectal involvement in a subset of ovarian cancer patients, particularly in advanced tumor stages, its impact on surgical decision-making, oncological outcomes, and physicians' choice for neoadjuvant chemotherapy was limited. The findings suggest that intraoperative assessments remain the primary determinant for colorectal interventions. Future prospective studies are warranted to clarify the clinical utility of colonoscopy in preoperative evaluation and its potential influence on interdisciplinary surgical strategies.
Retrospectively registered study
24-1364-S1-retro