Abstract
Around 60% of ovarian cancer is diagnosed in advanced stage – FIGO III or IV. Five year survival trends for women with this diagnosis have changed little, but it is stated that progression-free and overall survival is better in patients who have had a complete resection of the cancer. In order to achieve the best surgical result, one has to use „anatomical surgery“: En bloc resection for advanced ovarian cancer means using optimal anatomical approach to the tumor in a situation where the entire abdomen is the surgical compartment, which is the case for advanced ovarian cancer. The rational for using en bloc resection is the reported high rate of complete debulking, which means better survival outcome. Using anatomical landmarks and systematic approach to tumor could results in smaller blood loss in a situation where the oncological disease itself can raise the risk of perioperative bleeding. Less blood loss means smaller need for blood transfusion. Perioperative blood transfusion has been shown to be a predictor of early post-operative mortality. When blood loss is smaller and the surgery is completed with optimal movements, the operating time is shorter. Operation time and the amount of blood transfusion are related to possible intestinal anastomosis problems. Shorter operation can mean the possibility to offer more radial cytoreductive surgery for elderly patients. More than half of ovarian cancer cases are diagnosed in women aged 65 and over. Unfortunately, elderly people have shown to have less chance of receiving standard therapy. En bloc resection cases in literature have shown acceptable complication rates. Reducing operation time and blood loss means in general quicker recovery, shorter hospital stay. With optimal anatomical technique being established in a center, it is possible to teach and assess the surgeons in a more optimal way. It has been shown that structured management programs affect the rate of complete debulking and overall survival.
Highlights
En bloc resection could potentially be a method which allows achievement of surgical and postoperative goals in the most optimal way Around 60% of women are diagnosed with advanced stage ovarian cancer – FIGO stadium III or IV [1]
In a population study from Denmark [19] the analysis showed that ovarian cancer was less treated in elderly – they less often had surgical treatment, especially in advanced stages
Its surgical treatment needs anatomical surgery – en bloc resection can offer that approach with possible advantages for survival
Summary
Around 60% of women are diagnosed with advanced stage ovarian cancer – FIGO stadium III or IV [1]. Our hypothesis is that en bloc resection, as a specific surgical technique/approach to tumor removal, can provide a potential survival benefit for patients with advanced stage ovarian cancer. In conclusion: for patients with advanced stage ovarian cancer, the survival outcome is influenced mostly by the FIGO stadium of the disease and the level of resection of the tumor. It was necessary to approach the pelvis retroperitoneally in 64% of optimally cytoreduced patients, which suggests that this technique has an important clinical role in the treatment of patients with advanced ovarian cancer [29] These articles here presented used the en bloc resection, but the primary outcome for these studies was not the analysis of this technique, but mostly intestinal anastomosis outcome. Surgical outcome is to a far extent variable and amendable for being influenced by the therapists [10]
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