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Abstract
Objective
We
evaluated the role of omental bursa (OB), surface of the pancreas,
lesser omentum, caudate lobe, celiac nodes (CNs), portal nodes and triad
nodes spread in advanced ovarian cancer (AOC). We investigated if the
exploration and cleaning up of these areas can lead to a more complete
cytoreduction and to a more realistic assessment of residual tumor in
AOC.
Methods
We prospectively
recruited patients diagnosed with AOC, who underwent a complete
cytoreduction. Demographics, surgical procedures, morbidities,
pathologic findings and correlations with OB spread were assessed.
Results
A
total of 37 patients had an optimal debulking including OB evaluation
and peritonectomy. The OB area procedure required in mean 65 min with an
estimated blood loss of 250 ml. OB involvement was found in 67% (25/37)
of cases. Peritoneal disease was found in 22 cases including 18
supragastric lesser sac and 4 porta hepatis peritoneum. CNs metastases
were found in 5 cases, of which 3 cases are with bulky nodes, all
presented also bulky nodes in the para-aortic area. Only in the case of a
macroscopic involvement of the diaphragm OB was positive for disease.
When adhesions occluding the Winslow foramen were present, no OB
peritoneum involvement was found. OB resection related complications
were low (2 out 25).
Conclusions
The
data of this prospective study demonstrate the high rate of OB, surface
of the pancreas, lesser omentum, caudate lobe, CNs, portal and triad
nodes involvement and the value of investigating the dissemination and
cytoreduction in these sites to obtain a real optimal debulking.
Highlights
►
Omental bursa area is frequently involved by disease in advanced
ovarian cancer.
► To achieve an optimal debulking, omental bursa and celiac nodes should be routinely evaluated.
► To achieve an optimal debulking, omental bursa and celiac nodes should be routinely evaluated.
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