Blogger's Note: the abstract does not discuss the patient outcomes related to
quality of life
abstract
OBJECTIVE:
The
aim of this paper was to describe the operative details for
en bloc
removal of the adnexal tumor, uterus, pelvic peritoneum, and
rectosigmoid colon with colorectal anastomosis in advanced epithelial
ovarian cancer patients with widespread pelvic involvement.
METHODS:
The
patient presented with good performance status and huge pelvic tumor
extensively infiltrating into adjacent pelvic organs and obliterating
the cul-de-sac. The patient underwent en bloc pelvic resection as
primary cytoreductive surgery. En bloc pelvic resection procedure is
initiated by carrying a circumscribing peritoneal incision to include
all pan-pelvic disease within this incision. After retroperitoneal
pelvic dissection, the round ligaments and infundibulopelvic ligaments
are divided. The ureters are dissected and mobilized from the
peritoneum. After dissecting off the anterior pelvic peritoneum
overlying the bladder with its tumor nodules, the bladder is mobilized
caudally and the vesicovaginal space is developed. The uterine vessels
are divided at the level of the ureters, and the paracervical tissues
(or parametria) are divided. The proximal sigmoid colon is divided above
the most proximal extent of gross tumor using a ligating and dividing
stapling device. The sigmoid mesentery is ligated and divided including
the superior rectal vessels. The pararectal and retrorectal spaces are
further developed and dissected down to the level of the pelvic floor.
The posterior dissection is progressed and moves to the right and then
to the left of the rectum. The rectal pillars including the middle
rectal vessels are ligated and divided. Hysterectomy is completed in a
retrograde fashion. The distal rectum is divided using a linear stapler.
The specimen is removed en bloc with the uterus, adnexa, pelvic
peritoneum, rectosigmoid colon, and tumor masses leaving a
macroscopically tumor-free pelvis. Colorectal anastomosis was completed
using stapling device.
RESULTS:
En
bloc pelvic resection was performed by total abdominal hysterectomy,
bilateral salpingo-oophorectomy, pelvic peritonectomy, and rectosigmoid
colectomy with colorectal anastomosis using a stapling device. Complete
clearance of pelvic disease leaving no gross residual disease was
possible using en bloc pelvic resection.
CONCLUSION:
En
bloc pelvic resection is effective for achieving maximal cytoreduction
with the elimination of the pelvic disease in advanced primary ovarian
cancer patients with extensive pelvic organ involvement.
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