Impatto della resezione sigma-retto in corso di chirurgia citoriduttiva sulla quality of life nelle pazienti affette da carcinoma ovarico avanzato: insights dallo studio SQUALO

Background: Quality of life (QoL) represents a key outcome in advanced ovarian cancer, particularly in the setting of increasingly aggressive cytoreductive surgery. The EORTC QLQ-C30 and QLQ-OV28 questionnaires, validated more than two decades ago, have been extensively used in clinical trials to compare primary debulking surgery (PDS) and interval debulking surgery (IDS). However, their ability to capture bowel-related functional impairment following extensive surgery remains uncertain. Methods: In the SQUALO study, QoL was assessed using the EORTC QLQ-C30 and QLQ-OV28 questionnaires in patients undergoing cytoreductive surgery with or without bowel resection. Comparisons were performed between patients with no bowel resection and those undergoing bowel resection in the early postoperative period and at follow-up beyond 6 months. Operative complexity, including operative time and peritoneal cancer index (PCI), was analyzed, and survival outcomes were evaluated using Kaplan–Meier analysis. Results: Bowel resection was associated with significantly longer operative time and higher PCI values. Primary debulking surgery was performed in 48.2% of patients without bowel resection and in 65.6% of patients undergoing bowel resection. In the early postoperative period, patients undergoing bowel resection reported significantly higher pain, dyspnea, and diarrhea scores, while no differences were observed in functional scales or global health status. At follow-up beyond 6 months, quality of life was comparable between groups, with the exception of higher insomnia scores in the bowel resection group. No significant differences in progression-free or overall survival were observed among surgical subgroups. Conclusions: Sigmoid–rectal resection during cytoreductive surgery for advanced ovarian cancer is associated with increased surgical complexity and transient postoperative symptom burden but does not result in sustained impairment of global quality of life or survival. Given the limited ability of EORTC questionnaires to detect bowel-specific dysfunction, the integration of dedicated instruments such as the Padova Survey may improve the assessment of quality of life in both clinical practice and future clinical trials.