title: En bloc pelvic resection for advanced ovarian cancer preceded by central ligation of vessels supplying the tumor bed: a description of surgical technique and a feasibility study.
abstract: BACKGROUND
  The resection of all visible malignancies increases the likelihood for long-term survival in epithelial ovarian cancer. The complete extinguishment of pelvic disease is possible using en bloc pelvic resection. The no-touch isolation technique aims to reduce cancer cells flowing from the primary tumor site to the liver and other organs by ligating blood and lymphatic vessels first. objectives are to present the operative details and to establish the feasibility of the modified technique of en bloc pelvic resection, which begins with the central ligation of vessels supplying the tumor bed.
  
  
  METHODS
  Twenty patients with pelvic tumor extensively infiltrating into adjacent pelvic organs were uniformly operated on. The surgical plan commenced with incisions along the lateral peritoneal reflections immediately medial to the white line of Toldt followed by a retroperitoneal central ligation of ovarian and mesenteric vessels and the ovarian lymphovascular flow. Then, the routine steps of en bloc pelvic resection were performed. Data on treatment were assessed.
  
  
  RESULTS
  In all cases, no gross residual disease was achieved. The median durations of the surgical procedure and the hospital stay were 320 min (range: 205-430 min) and 12 days (range: 7-44 days), respectively. The complications were as follows: wound infection (n = 1), anastomosis dehiscence (n = 1), total parenteral nutrition (n = 4), and death (n = 1, PE). The median follow-up time period was 19 months (range: 8-31 months). No patient experienced a recurrence of pelvic disease.
  
  
  CONCLUSIONS
  Performing a central ligation of vessels supplying the tumor bed prior to an en bloc pelvic resection is feasible with acceptable morbidity and mortality rates.
authors.affiliation: Department of Surgical Oncology, The Medical University of Gdańsk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland. jacek.sznurkowski@gumed.edu.pl.
authors.forename: Jacek Jan
authors.initials: JJ
authors.lastname: Sznurkowski
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D012007:Rectum; D015996:Survival Rate
keywords: Complete pelvic peritonectomy; Cytoreduction; En bloc pelvic resection; No-touch isolation; Ovarian cancer; Surgery