Primary ovarian clear cell carcinoma of the abdominal wall--a systematic review of the literature to establish optimal surgical management.
Primary ovarian clear cell carcinoma of the abdominal wall (AW-OCCC) is an extremely rare occurrence. Therefore, data on the prognosis and treatment regime remain limited.


OBJECTIVE
The aim of the study was to provide an evidence-based review of the available case reports to establish optimal surgical management.


METHODS
A literature search according to PRISMA guidelines was performed using PubMed database (from 01.01.1990 to 31.12.2013) with the terms: "clear cell carcinoma" and "abdominal wall". A total of 17 case reports on 18 patients with full text available were identified.


RESULTS
All AW-OCCC's appeared after previous laparotomy for gynecological reasons, with cesarean section as the predominant intervention (15/18, 83%). Median age was 46 years (range 37-56) and median time elapsed between the initial laparotomy and the cancer was 19 years (range 9-30). Data on the course of the disease were available for 17 cases. The overall median follow-up was 11 months (range 1-60). No cases of metastatic spread to the ovaries or the intraperitoneal cavity were observed. Eight patients experienced recurrence (8/17, 47.1%). Metastatic lymph nodes appeared in 6 of the 8 relapsed women and local recurrence in the remaining 2 subjects. There were 4 fatal cases (4/17, 23.5%), including 3 with lymphatic cancer spread. The women with treatment failure (recurrence or death) more frequently developed lymph node metastases than the curable cases (p=0.002).


CONCLUSIONS
Radical resection of the tumor with concomitant pelvic lymph nodes dissection seems to be the most suitable surgical approach. The need for comprehensive intraperitoneal surgical staging for ovarian cancer is questionable.
Aleksandra
A
Ohler
Mirosław
M
Dudziak
Jacek Jan
JJ
Sznurkowski
D000008:Abdominal Neoplasms / Q000473:pathology / Q000601:surgery*; D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery*; D018262:Adenocarcinoma, Clear Cell / Q000556:secondary / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*