# Comparison of Pelvic Peritonectomy vs. Rectosigmoid Resection During Hudson Procedure for Advanced Ovarian Cancer: 6-Year Experience of an ESGO-Certified Center

## TL;DR

A study compares two surgical techniques for advanced ovarian cancer and finds similar survival rates but higher complication risks with one method.

## Contribution

The study provides a 6-year comparison of pelvic peritonectomy and rectosigmoid resection in advanced ovarian cancer surgeries.

## Key findings

- Rectosigmoid resection was linked to higher surgical complexity and complication rates but no survival benefit.
- Pelvic peritonectomy achieved similar survival outcomes with lower morbidity when complete resection was possible.
- Residual disease and postoperative complications were key prognostic factors for survival.

## Abstract

This retrospective cohort compared pelvic peritonectomy (PP) versus rectosigmoid resection (RR) during the Hudson procedure in patients with advanced ovarian cancer and cul-de-sac involvement. Ninety-three women were treated in an ESGO-certified center between 2017 and 2022 were included and divided into RR (n = 34) and PP (n = 59) groups with comparable baseline characteristics and high complete gross resection rates (>70%). RR was more often performed in primary debulking and was associated with higher peritoneal cancer index (PCI) and surgical complexity score, longer operating time, increased ICU admission, longer hospitalization and higher overall postoperative complication rates, without an increase in major (grade III) events. Progression-free and overall survival did not differ significantly between the two groups. Multivariable Cox regression identified residual disease and total postoperative complication rate as independent prognostic factors for both survival endpoints.

(1) Background: Hudson first described the procedure that includes en-block removal of an ovarian tumor fixed in the pelvis with the whole pelvic peritoneum and invaded surrounding structures. However, sometimes pelvic peritonectomy (PP) with or without shaving of the bowel serosa is not enough to achieve complete cytoreduction, and en-block rectosigmoid resection (RR) is necessary. This study aims to investigate the impact of bowel surgery on survival rates and morbidity of patients with advanced ovarian cancer. (2) Methods: We retrospectively analyzed patients with advanced ovarian cancer with cul-de-sac involvement that underwent debulking surgery at the 1st Department of Obstetrics—Gynecology of “Papageorgiou” General Hospital, from 2017–2022. The primary outcomes were the survival rates and morbidity between PP and RR. (3) Results: A total of 93 patients met the inclusion criteria. Patients were categorized into two groups: Group A (34 patients) with RR and Group B (59 patients) with PP. There was no statistically significant difference in the majority of patients’ characteristics and oncological outcomes. On the other hand, patients with RR had a significantly higher surgical complexity score (SCS), peritoneal cancer index (PCI), ICU admission, rate of postoperative complications, longer surgery duration and hospital stay. When comparing the duration of surgery, the RR group has significantly higher operation time during primary compared to interval debulking surgery. Concerning survival rates, there was no significant difference in progression-free (PFS) (p = 0.22) and overall survival (OS) (p = 0.85) between the two groups, while residual disease and postoperative complications were identified as independent prognostic factors for PFS and OS; (4) Conclusions: The modified Hudson procedure with RR is a safe and reproductible technique, but when complete gross resection can be achieved with PP, this technique is preferred in order to avoid increased patient’s morbidity.