Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer—Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction (original) (raw)
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Gynecologic oncology, 2015
To evaluate the complication rate and its impact in patients who have undergone upper abdominal surgery for treatment of advanced ovarian cancer. Patients who have undergone upper abdominal surgery including diaphragm surgery, splenectomy, distal pancreatectomy, gastric resection, liver resection and biliary surgery were considered for the study. Perioperative complications were evaluated and graded according to Clavien-Dindo. One hundred and twenty one patients were included. Two hundred and twelve surgical procedures were performed. Thirty-six patients reported at least one complication, but 61.1% of these the complication was mild. Median hospital stay for patients with and without complication was 7 vs. 13days respectively (p<0.001). There was a significant correlation between post-operative hospital stay and the total number of surgical procedures (R=0.445, p<0.001). At multivariate analysis, diaphragmatic resection and pancreatic resection were associated with a signific...
Cytoreductive surgery in ovarian cancer
Cancer Imaging, 2007
As the overall prognosis for patients with ovarian cancer is poor, the management of this condition should be restricted to expert multidisciplinary teams in gynaecological oncology. Apparent early stage ovarian cancer requires accurate and complete staging so that potential sites for metastases are not missed. Omitting adequate staging may have significant consequences including a negative impact on survival rates in young patients. The challenge with advanced ovarian cancer is to obtain a detailed appreciation of the extent of disease. This information allows treatment with primary chemotherapy if the cancer is considered to be inoperable and/or the general condition of the patient renders her unfit for appropriate surgery. Available data would suggest that a 5-year survival rate of 50% is only possible for those patients who have had complete cytoreduction of all tumour. Therefore, the best surgical option for patients with advanced ovarian cancer is a complete primary surgical procedure that achieves complete clearance of the abdominal cavity rather than optimal surgery that leaves tumour nodules up to 1 cm in diameter in situ in the patient.
Right Upper Abdominal Resections in Advanced Stage Ovarian Cancer
In Vivo, 2020
Background/Aim: The right upper abdominal involvement is frequently encountered in patients with advanced stage ovarian cancer. The aim of this paper is to study the safety and efficacy of extended resections at this level as well as to determine the sites of residual disease. Patients and Methods: Between January 2016 and December 2019, 26 patients submitted to right upper abdominal resections were identified. Results: Peritoneal stripping and full thickness resections were the most commonly performed resections (in 57% and 19% of cases, respectively), followed by capsular liver resection and atypical liver resection (in 30% and 23% of cases, respectively) while the most common sites where resection was incomplete were the liver pedicle and porta hepatis. Exceptionally, one case necessitated performing a pancreatoduodenectomy as part of debulking surgery. Postoperatively, two cases developed serious complications and required reintervention; however, the overall mortality was null. Conclusion: Right upper abdominal resections seem to be feasible and effective in order to maximize the debulking effort with acceptable risks arising from perioperative complications.
Journal of the Turkish-German Gynecological Association
Objective: "en-bloc" resection of pelvic tumor in ovarian cancer is still under debate. We aimed to analyze our results in a series of patients with ovarian cancer who underwent "en-bloc" pelvic disease resection as part of cytoreductive surgery. Material and Methods: Clinical and surgical records from sixty patients with ovarian carcinoma who underwent the above mentioned surgery and were retrospectively analyzed. Results: Patients' mean age was 56 years, 36 patients had primary disease and 24 had recurrence disease. Carcinomatosis was present in 46.7% of patients. Primary surgery was done in 49 women and interval debulking surgery in eleven cases Complete cytoreduction was achieved in 55.0% and optimal in 38.3% of patients. Carcinomatosis significantly decreased the probability of complete cytoreduction (OR: 0.22) (p=0.021). Mesorectal infiltration occurred in 83% of patients. Risk of death was higher (HR: 1.9), but not statistically significant, in women with mesorectal infiltration. Median OS was longer for patients without infiltration (46.1 vs 79.1 months) (p=0.15). Eighty-five percent suffered from mild to moderate complications and CRA leak occurred in two patients (3.6%) with CRA below 6cm. Diaphragm resection had more than 5 times the risk of major complications (OR: 5.35) (p=0.014). There was no three months mortality. Conclusion: When contiguous gross extension of disease to pelvic peritoneum and sigmoid colon is found, in patients with AOC, microscopic involvement of the mesorectum and intestinal wall is present in most cases making "en bloc" resection necessary if complete cytoreduction is to be achieved. The associated morbidity is acceptable.
Laparoscopic Cytoreduction for Primary Advanced Ovarian Cancer
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2010
Introduction: We evaluated the feasibility of laparoscopic cytoreduction for primary advanced ovarian cancer. Methods: All patients with presumed stage 3/4 primary ovarian cancer underwent attempted laparoscopic cytoreduction. All patients had CT evidence of omental metastasis and ascites. A 5-port (5-mm) transperitoneal approach was used. A bilateral salpingo-oophorectomy, supracervical hysterectomy, and omentectomy were performed with PlasmaKinetic (PK) cutting forceps. A laparoscopic 5-mm Argon-Beam Coagulator was used to coagulate tumor in the pelvis, abdominal peritoneum, intestinal mesentery, and diaphragm. Results: Nine of 11 cases (82%) were successfully debulked laparoscopically without conversion to laparotomy. Median operative time was 2.5 hours, and median blood loss was 275 mL. All tumors were debulked to Ͻ2 cm and 45% had no residual disease. Stages were 1-3B, 7-3C, and 1-4. Median length of stay was one day. Median VAS pain score was 4 (discomforting). Two of 11 patients (18%) had postoperative complications. Conclusion: Laparoscopic cytoreduction was successful and resulted in minimal morbidity. Because of our small sample size, additional studies are needed.
Journal of Clinical Gynecology and Obstetrics, 2015
Background: The aim of the study was to evaluate the initial efficiency and security of maximal effort cytoreductive surgery in stages III and IV of ovarian cancer at a university hospital. Methods: Thirty-four patients with stage III and IV ovarian carcinoma underwent surgery between January 2013 and June 2014 in the University General Hospital of Castellon (Spain). Patients with primary and relapse ovarian cancer were included. The extent of disease, type of surgical technique, amount of tumor prior to surgery and amount of residual disease after surgery were recorded. To quantify the efficiency and the security of the procedure, the complete cytoreduction and the morbidity and the mortality rates were described. Results: Of the patients 26.4% received neoadjuvant chemotherapy. Complete cytoreductive surgery, without evident residual tumor at the end of the procedure, was obtained in 79% of patients and optimal cytoreductive surgery (CC0-CC1) in 91%. Surgical complications were found in 56% of patients and two deaths (6%) occurred attributable to surgery. The disease free interval was 15 months. Conclusions: This study confirms that with experienced multidisciplinary teams and in tertiary referral hospitals, 79% of complete cytoreduction surgery in advanced ovarian cancer can be achieved but they must be prepared to deal with a high rate of complications.
6 Controversial aspects of cytoreductive surgery in epithelial ovarian cancer
Baillière's Clinical Obstetrics and Gynaecology, 1989
Epithelial ovarian cancer is usually asymptomatic until it disseminates around the peritoneal cavity, so that about 70% of patients have advanced disease at initial presentation. Total surgical resection of all tumour is usually impossible for these patients, so that the surgical options are either biopsy only, limited surgery to include resection of the primary tumour, or aggressive cytoreductive surgery. Cytoreductive or debulking surgery is a procedure whereby surgically incurable tumour is partially removed in order to improve the effectiveness of subsequent therapy, usually chemotherapy or radiation. It contravenes traditional principles of cancer surgery because clear surgical margins are not always obtained. Hence, it has remained somewhat controversial, and has come under frequent criticism. Meigs was the first to suggest that as much tumour as possible should be removed in order to enhance the effect of postoperative irradiation (Meigs, 1935). Munnell (1968) reported an overall increase in survival of patients with ovarian cancer from 28% to 40% and concluded that this improvement was related to more frequent use of postoperative irradiation and more aggressive surgical resection of tumour. Munnell introduced the concept of the maximum surgical effort, but Griffiths was the first to quantify the surgical objective. Griffiths suggested that all tumour nodules should be reduced to 1.5 cm or less in diameter (Griffiths, 1975). Subsequently, both Hacker and van Lindert reported further enhancement of survival when all metastatic masses larger than 5 mm were resected (Hacker et al, 1983; van Lindert et al, 1984) (Figure 1). It has been conventional to refer to an 'optimal' cytoreductive operation as one which eliminates all tumour nodules having a diameter larger than 1.5cm. This convention allows comparison between different studies. Where centres have a particular interest and expertise in cytoreductive surgery, optimal cytoreduction is possible in about 85% of patients (Chen and Bochner, 1985; Heintz et al, 1986; Griffiths, 1987). Feasibility increases with the experience of the surgical team. On the basis of the results of three recent national cooperative ovarian cancer trials, it must be concluded that most patients with advanced ovarian
The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review
It has already been proven that ovarian cancer is the sixth most common cancer among women, and it is considered the leading cause of death by gynecologic cancer in developed countries. This article is a literature review based on the use of cytoreductive surgery matched with adjuvant chemotherapy in advanced-stage ovarian cancer. According to the statistics, the difficulty of obtaining an early diagnosis results in a delay in the disease treatment and as a consequence, in many cases, ovarian cancer is still diagnosed in the advanced stage of the disease. Primary surgery is performed, in addition to diagnosis and staging, to achieve optimal cytoreduction. The purpose of this article is to review the different surgical approaches in the management of epithelial ovarian cancer, specifically the high-stage disease, with a special concentration on the most recent therapeutic additions to our current knowledge, such as hyperthermic intraperitoneal chemotherapy and new therapeutic drugs. ...
American Journal of …, 2005
Objective: The purpose of this study was to 1) report on the distribution of bowel segments resected in a population of patients who underwent primary optimal cytoreductive surgery for epithelial ovarian cancer, and 2) discuss implications for surgical management regarding resection of these bowel segments. Study design: This was a retrospective study from 1995 to 2003 of 144 ovarian cancer patients who underwent primary optimal cytoreductive operations that included bowel resection. Results: Bowel segments removed and major complications are presented in tabulated form. Eighty-one out of 144 resections were rectosigmoid only. Thirty-six percent had extensive involvement of colon segments separate from the rectosigmoid. Excluding hemorrhage, 9 patients (6%) experienced a major complication. Conclusion: The present study does suggest the necessity for a highly individualized approach to the surgical management of epithelial ovarian cancer patients who can be optimally cytoreduced by resection of multifocal colonic involvement. Further study is needed to better assess the complications, function, and oncologic outcome of the different surgical approaches to these patients.
Romanian Journal of Medical Practice
The aim of this study is to analyze the feasibility and safety of left upper abdominal resections as part of debulking surgery. Case series presentation. Between January 2015 and August 2019, 32 patients were submitted to left upper abdominal resections. Left upper abdominal resections were performed as part of primary cytoreduction in 22 cases, as part of secondary cytoreduction in eight cases, and respectively as part of tertiary cytoreduction in two cases. The complexity of the resection increased from primary to secondary and tertiary cytoreduction; in the meantime, the rates of postoperative complications also increased with the attempt of cytoreduction. Therefore the postoperative morbidity rate was of 27% at the time of primary cytoreduction, 37.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. However, association of left upper abdominal resections leaded to a complete resection rate of 77% at the time of primary cytoreduction, 62.5% at the time of secondary cytoreduction and 50% at the time of tertiary Case presentations