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, I2 = 60%, p = .97; 3 studies, 495 participants) or pelvic recurrences (OR 1.61, 95% CI 0.23 to 11.53, I2 = 88%, p = .63; 3 studies, 495 participants). Similarly, there were no significant differences in 5-year disease-free survival (OR 0.91, 95% CI 0.13 to 6.43, I2 = 91%, p = .93; 2 studies, 317 participants), or 5-year overall survival (OR 1.02, 95% CI 0.39 to 2.62, I2 = 83%, p = .97; 4 studies, 623 participants). Operative time, stoma rate, blood loss, blood transfusion, and length of hospital stay were significantly higher in the rectosigmoid resection group in the studies where these outcomes were assessed. 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.