Standard primary cytoreduction surgery (CRS) procedure for ovarian cancer (FIGO Stage IIB-IV)

A T Teichman,Iqra Ijaz,Wang Qin,Chen Yi,Wang Chunyan,Ding Shugui,Li Zhu

doi:10.4038/sljog.v41i2.7885

Abstract

In gynecologic oncology the ovarian cancer has become one of the leading cause of death in women. Overall prognosis for ovarian cancer patients is poor, therefore the management of this condition is restricted to expert multi-disciplinary teams (MDT) in gynecological oncology. Ovarian cancer requires accurate and complete staging so that the metastatic sites are not missed, omitting adequate staging can have significant consequences including a negative impact on survival rates. Thus the goal for survival benefit of ovarian cancer is to surgically remove all visible macroscopic tumor, because the complete cytoreductive surgery (CRS) has been shown to be associated with prolonged survival. In a remarkable number of women, complete CRS is very challenging. Especially in those with many small metastases on the peritoneal and intestinal surfaces. Primary CRS has been in practice for long time as an effective method of treating peritoneal metastases (PM) from ovarian cancer, it comprises extensive peritonectomy procedures and en bloc visceral resection. CRS is a technically challenging surgery that requires a considerable amount of skill and appropriate patient selection. Even though there are several conflicts on primary CRS but due to lack of strong evidence against comparable efficacy of primary CRS with adjuvant chemotherapy and neoadjuvant chemotherapy with interval debulking surgery, the former stays the priority, remaining the preferred method of management and which is practiced in western countries routinely. This article is a review of the CRS techniques we are currently performing for primary CRS, hereby we have described the operative details for removal of cancer in advanced epithelial ovarian cancer patients with widespread pelvic and abdominal involvement.

Highlights

Ovarian cancer is the third most common gynecological cancer in women worldwide and is the fifth leading cause of cancer-related death[1]
Hysterectomy is completed in a retrograde fashion, pelvic peritonectomy along en bloc resection of pelvic viscera is completed (Figure 12) and we can remove the surgical specimen or afterward as we have shown later in the article
Surgical staging and resection of the tumor and other invaded tissues have a major impact on the prognosis and survival in the management of ovarian cancer respectively

Summary

Background

Ovarian cancer is the third most common gynecological cancer in women worldwide and is the fifth leading cause of cancer-related death[1]. Into simple and radical/ultra-radical surgical procedure performed as part of primary cytoreduction surgery, main goal of undertaking the CRS is to remove all the visible/ macroscopic tumor, leaving no residual disease behind, which can be achieved by complete/ultra-radical CRS where extensive peritonectomies along with en-bloc resection of the viscera is needed to be performed[2,3]. Another reason to leave no tumor residue behind is related with the effectiveness of upfront chemotherapy, which are nearly ineffective eradicating tumor nodules larger than 2.5 mm[4]. This article is the review of the complete procedure/technique of ultra-radical CRS we currently are using in our Gynecologic Oncology Center

Patient positioning and preparation

Exploratory Laparotomy:

En bloc resection of Viscera

Conclusion