Extended left upper quadrant resection during primary cytoreductive surgery for Stage IV ovarian cancer.
OBJECTIVE
The completeness of primary cytoreductive surgery for Stage IV epithelial ovarian cancer is associated with greater progression free survival and overall survival Winter et al. (2008) [1]. Cytoreduction to no gross residual disease in patients with bulky upper abdominal disease presents significant surgical challenges, highlighting the importance of specialized and comprehensive surgical training in the treatment of advanced ovarian cancers Zivanovic et al. (2008) [2]. Extensive upper abdominal surgical procedures have shown to improve the ability to achieve cytoreduction to no gross residual disease Chi et al. (2004) [3]. This film displays an extended left upper quadrant resection in one of our recent patients.


METHODS
The patient was a 62-year-old female with a CA-125 of 2,577U/mL, abdominal ascites, and a preoperative CT showing carcinomatosis with a left upper quadrant infiltration. Primary cytoreductive surgery was undertaken with exploratory laparotomy, type 2 radical oophorectomy (en bloc modified radical abdominal hysterectomy, bilateral salpingo-oophorectomy, pan-pelvic peritonectomy, distal colectomy, retosigmoid colectomy), with en bloc omentectomy, transverse colectomy, splenectomy, distal pancreatectomy, and diaphragm peritonectomy.


RESULTS
Operative time was 337min with an estimated blood loss of 900mL. The patient was discharged home on post-operative day 10 after a standard prolongation in hospitalization required to meet milestones after extensive upper quadrant cytoreductive surgery.


CONCLUSIONS
Bulky upper abdominal disease can present significant surgical challenges. This film illustrates obtaining cytoreduction to no gross residual disease is feasible. We show transection of the pancreas by reinforced linear staple closure due to its ease of use and surgeon preference, although controversy remains regarding the ideal technique.
Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA; Division of Gynecologic Oncology, Irvine Medical Center, University of California, Orange, CA, USA.
Brandon T
BT
Sawyer
Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA; Division of Gynecologic Oncology, Irvine Medical Center, University of California, Orange, CA, USA.
Christopher J
CJ
LaFargue
Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA; Division of Gynecologic Oncology, Irvine Medical Center, University of California, Orange, CA, USA.
Robert E
RE
Bristow
D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*
Carcinomatosis; Cytoreductive surgery; Diaphragm resection; Distal pancreatectomy; Ovarian cancer; Partial colectomy