Contribution of adding routine endoscopy and colonoscopy to preoperative screening of patients with suspected ovarian cancer on surgical and oncological outcomes

Aim: Examine the contribution of preoperative endoscopy and colonoscopy screening to surgical and oncological outcomes in patients followed up with suspected ovarian cancer. Materials and Methods: The files of 1446 patients who were operated on with the suspicion of ovarian cancer or treated with the diagnosis of ovarian cancer in our hospital between August 17, 1992 and November 27, 2018 in the Department of Obstetrics and Gynecology of Cukurova University Balcali Hospital were retrospectively analyzed. Patients whose pathology results were borderline tumor, teratoma, sartoli-leydig cell tumor and yolksac tumor were excluded from the study. 910 patients diagnosed with epithelial ovarian cancer were included in the study. Of these patients, 676 patients between Stage 2 and Stage 4 were analyzed. While the patients were included in the study: these patients were included in the study by seeing the documents indicating that their surgeries, examinations and medical treatments were performed in our hospital or that they were performed in other hospitals. When analyzing the patients: Age range, body mass index, menopausal status, parity status, comorbidity, tumor marker values (CEA, CA19.9, CA125, CA15.3), amount of preoperative acid, accompanying symptom at the time of diagnosis, preoperative tumor diameter, debulking surgery type (primary-interval), cytoreduction adequacy, primary operation type, adjuvant chemotherapy type, duration of adjuvant chemotherapy, appendectomy status, upper abdomen surgery status, preoperative complication status, postoperative complication status, tumor histology, parameters such as tumor histological grade, tumor stage, tumor type (classified according to the dualistic model), endoscopy application status, colonoscopy application status, patient's condition and recurrence status were examined one by one. When examining Endoscopy and Colonoscopy parameters; patients endoscopy and colonoscopy; were not applied, they were divided into 3 groups as there is malignancy and no malignancy. In patients who underwent Endoscopy and Colonoscopy screening in our hospital Endoscopy and Colonoscopy procedures were performed by internal medicine gastroenterology professors and gastgastroenterology fellowship research residents. SPSS 23.0 package program was used for statistical analysis of the data. Categorical measurements were summarized as numbers and percentages, and continuous measurements as mean, deviation, and minimum to maximum. Chi-square test and Fischer's Precision Test were used to compare categorical variables. Statistical significance level was taken as 0.05 in all tests Results: The mean age at diagnosis of the patients was 54.7±12.4; The median age at diagnosis was 55 years. The mean body mass index of the patients was 27.6±4.9; the median body mass index value was 27.1. It was determined that 67.8% of the patients included in the study were in the postmenopausal period and 32.2% were in the reproductive period. 84.6% of the patients were multiparous and 10.7% of them were nulliparous. The most common symptom at the time of diagnosis was abdominal pain in 71.2%, the second most common symptom was abdominal distension in 22.3%. There was no significant difference between the presence of bowel resection and laboratory findings (p>0.05). While postoperative CA125 values were observed to be higher in patients with intestinal metastasis (p0.05). While there was no significant difference between the presence of intestinal metastasis and preop acid findings; Preoperative tumor diameter value was found to be higher in patients with intestinal metastasis (p0.05). It was determined that the mean survival time of the patients who underwent was low (p>0,05) Conclusion: There is not any routine screening protocol in ovarian cancer. In many clinics, screening endoscopy and colonoscopy are performed for patients who are thought to have ovarian cancer and gastrointestinal system metastasis. Since seromuscular involvement is usually seen in intestinal metastases of ovarian cancer, the sensitivity of colonoscopy in screening is low. Endoscopy and colonoscopy screening are costly. In addition, it is not a non-invasive procedure and may cause discomfort and agitation in patients. When all these are evaluated; Risk-adjusted endoscopy and colonoscopy screening may be a more reasonable strategy for patients. Keywords: Ovarian cancers, epithelial ovarian cancers, screening in ovarian cancers, endoscopy and colonoscopy