Colorectal Surgeon Participation in Cytoreductive Surgery for Advanced Epithelial Ovarian Cancer: Improved Optimal Resection Without Increased Perioperative Morbidity—A Single-Center Retrospective Study

Background Advanced epithelial ovarian cancer frequently involves bowel structures, requiring multidisciplinary surgical expertise. This study evaluates the impact of colorectal surgeon participation on surgical outcomes in cytoreductive surgery (CRS) for FIGO stage III/IV disease. Methods We retrospectively analyzed 254 patients who underwent cytoreductive surgery at a single institution between January 2020 and December 2025. Patients were stratified into two groups based on colorectal surgeon participation: the participation group (n = 97) and the non-participation group (n = 157). The primary outcome measures included operative time, intraoperative blood loss, time to first postoperative flatus, length of postoperative hospital stay, R0 resection rate, and postoperative complications. Multivariable logistic regression was used to adjust for key confounding factors, including bowel involvement, FIGO stage, age, and neoadjuvant chemotherapy status. Results Bowel involvement was significantly higher in the colorectal surgeon participation group (94.8% vs. 17.8%, P < 0.001), which is consistent with clinical practice whereby colorectal surgeons were primarily involved in cases with overt bowel invasion requiring bowel resection. Despite this, perioperative outcomes were comparable between groups, including operative time (P = 0.18), intraoperative blood loss (P = 0.12), time to first flatus (P = 0.45), length of hospital stay (P = 0.62), and major postoperative complications (all P > 0.05; no anastomotic leaks or perioperative deaths). The R0 resection rate was markedly higher with colorectal surgeon participation (44.3% vs. 18.5%, P < 0.001).Multivariable analysis confirmed colorectal surgeon participation as an independent predictor of R0 resection (adjusted OR 2.32, 95% CI 1.35–3.98, P = 0.003), with no independent effect on the occurrence of complications (adjusted OR 0.92, 95% CI 0.55–1.54, P = 0.74). Conclusions Colorectal surgeon participation in cytoreductive surgery for advanced epithelial ovarian cancer enables significantly higher rates of complete (R0) resection in cases with substantial bowel involvement, without increasing perioperative morbidity or complications. These findings support the integration of multidisciplinary surgical teams to optimize oncologic outcomes in complex disease while maintaining safety, particularly in settings where specialized bowel surgery expertise may be limited among gynecologic oncologists.