Impact of Bowel Resection on Operative Mortality and Overall Survival in Advanced Epithelial Ovarian Cancer

<b>Background/Objectives</b>: Bowel resection may be necessary during cytoreductive surgery (CS) in advanced epithelial ovarian cancer to achieve complete tumor removal. However, concerns about increased perioperative risks and unclear survival benefits have led to ongoing debate. This study aimed to evaluate the impact of bowel resection on perioperative mortality and overall survival (OS) in patients undergoing CS. <b>Methods</b>: We retrospectively reviewed 127 patients with FIGO stage IIB-IV epithelial ovarian cancer who underwent primary or interval CS between 2007 and 2021. Patients were stratified based on the performance of bowel resection. Clinical, surgical, and survival data were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards modeling. Primary outcomes were 90-day mortality and OS. <b>Results</b>: Bowel resection was performed in 58 patients (46%) with more extensive disease and poorer ECOG performance scores. Although the resection group had increased perioperative risks (e.g., higher transfusion rates and ICU use), OS was similar between groups (log-rank <i>p</i> = 0.122). Multivariate analysis identified that increasing age (HR = 1.042, <i>p</i> = 0.005) was independently associated with poorer OS, whereas lymph node dissection (HR = 0.450, <i>p</i> = 0.003) and undergoing primary CS (HR = 0.540, <i>p</i> = 0.047) were associated with improved survival. Bowel resection was not independently associated with OS. <b>Conclusions</b>: Bowel resection does not adversely affect OS when optimal cytoreduction is achieved. Although it increases perioperative complexity, it can be safely incorporated into CS in selected patients. These findings support its use as part of an individualized surgical strategy for advanced ovarian cancer.