title: En bloc pelvic peritoneal resection of the intraperitoneal pelvic viscera in patients with advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  We report the results of 30 patients who underwent en bloc resection of the pelvic peritoneum and all intraperitoneal pelvic viscera in the management of advanced epithelial ovarian cancer.
  
  
  METHODS
  Between 1989 and 1993, 30 consecutive patients with advanced epithelial ovarian cancer underwent en bloc resection of the pelvic peritoneum and all pelvic viscera, except for the bladder, with a rectosigmoid reanastomosis below the peritoneal reflection. All 30 patients were managed with gastrostomy and hyperalimentation. All patients received six cycles of platinum-based combination chemotherapy; the first cycle was administered prior to discharge.
  
  
  RESULTS
  All patients underwent cytoreduction to the largest residual mass less than 1 cm. No major complications were attributed to the gastrointestinal surgery itself. The median hospital stay was 11 days (range, 7-23). We found 26 recurrences (87%) and 14 deaths (47%). The median times to recurrence and death were 12.5 months (range, 8-24) and 23 months (range, 8-63), respectively. Sixteen of the 26 relapses (62%) were found in extraperitoneal locations and 10 (38%) in intraperitoneal locations. Only 3 (12%) of the 26 relapses presented with bowel obstruction.
  
  
  CONCLUSIONS
  En bloc resection of the uterus, ovaries, pelvic peritoneum, and rectosigmoid followed by low anterior anastomosis is a safe operation that facilitates complete cytoreductive surgery in poor prognosis patients with advanced epithelial ovarian cancer.
authors.affiliation: Vincent Memorial Gynecologic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sainz de la Cuesta
authors.forename: A
authors.initials: A
authors.lastname: Goodman
authors.forename: S S
authors.initials: SS
authors.lastname: Halverson
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D010385:Pelvic Exenteration / Q000379:methods*; D010388:Pelvis / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications; D014781:Viscera / Q000601:surgery*