BACKGROUND: Anastomotic leakage is a significant complication following bowel resection in cytoreductive surgery for ovarian cancer. Previous studies have highlighted the detrimental effects of anastomotic leakage on patients' postoperative course. However, there is still a lack of precise identification of the high-risk population and established strategies for preventing its occurrence. MATERIALS AND METHODS: Patients who underwent bowel resection within the surgical phase III trial AGO-OVAR.OP3/LION investigating the impact of systematic pelvic and paraaortic lymphadenectomy in cytoreductive surgery for primary ovarian cancer were included in this analysis. All patients in the AGO-OVAR.OP3/LION trial had undergone complete cytoreduction with no macroscopic residual disease. We analyzed the occurrence of anastomotic leakage regarding surgical procedure (non-lymphadenectomy vs. lymphadenectomy and non-stoma vs. stoma) using the Fisher test. Risk factors for anastomotic leakage and its prognostic impact on survival were analyzed. RESULTS: Overall rate of anastomotic leakage was 7.1%. Notably, the Non-lymphadenectomy subgroup had a lower anastomotic leakage rate of 3.0% compared to the lymphadenectomy subgroup (11.2%, P = 0.005). The use of protective stoma placement resulted in an anastomotic leakage rate of 5.5% regardless of lymphadenectomy compared to the Non-Stoma subgroup (7.5%, P = 0.78). Increased blood loss (odds ratio [OR] 1.04 per 100cc, 95% confidence interval [CI] 1.0001-1.09) and lymphadenectomy (OR 3.67, 95% CI 1.41-11.40) were associated with a higher risk of anastomotic leakage. Although anastomotic leakage demonstrated a numerical detrimental impact on median progression-free survival (PFS) (18 months with anastomotic leakage vs. 19 months with Non-anastomotic leakage, hazard ratio [HR] 0.86; 95% CI 0.5 to 1.4, P = 0.53) and median overall survival (OS) (31 months with anastomotic leakage vs. 58 months with Non-anastomotic leakage, HR 0.69; 95% CI 0.4 to 1.2, P = 0.17), the differences were not statistically significant. CONCLUSION: Anastomotic leakage rates were lower in the Non-lymphadenectomy arm, the current standard of care. Blood loss and lymphadenectomy, as surrogate markers for extensive surgery, were associated with increased risk for anastomotic leakage. These findings highlight the importance of strategies to reduce surgical complexity and perioperative risk to improve clinical outcomes.

Coordinating Center for Clinical Trials Philipps University Marburg Marburg Germany

Department of Gynecologic Oncology European Institute of Oncology University of Milan Italy

Department of Gynecology and Gynecologic Oncology Ev Kliniken Essen Mitte Essen Germany

Department of Gynecology and Gynecological Oncology Bonn University Hospital Bonn Germany

Department of Gynecology and Obstetrics University Hospital Giessen and Marburg Marburg Germany

Department of Gynecology and Obstetrics University of Duisburg Essen Essen Germany

Department of Gynecology and Reproductive Medicine and Center for Gynecologic Oncology Jena University Hospital Jena Germany

Department of Gynecology Charité Universitätsmedizin Berlin Berlin Germany

Department of Gynecology University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Obstetrics and Gynecology Heinrich Heine University Düsseldorf Germany

Department of Obstetrics and Gynecology LMU University Hospital LMU Munich Munich Germany

Department of Obstetrics Gynaecology and Neonatology General University Hospital Prague 1st Faculty of Medicine Charles University Czech Republic

Faculty of Medicine Institute for Medical Information Processing Biometry and Epidemiology IBE LMU Munich Munich Germany

Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del S Cuore Rome Rome Italy

Gynecologic Oncology Unit Fondazione IRCCS Istituto Nazionale Tumori Milan Italy

Oncologic Medical Center at the Jerusalem Hospital Hamburg Hamburg Germany

University Medical Center Mainz Department of Gynecology and Obstetrics Mainz Germany

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