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9 - ‘Ultra-radical’ surgery in advanced ovarian cancer

from SECTION 3 - IMAGING AND THERAPY: STATE OF THE ART

Published online by Cambridge University Press:  05 February 2014

Oliver Zivanovic
Affiliation:
Memorial Sloan-Kettering Cancer Center
Dennis S Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center
Sean Kehoe
Affiliation:
John Radcliffe Hospital, Oxford
Richard J. Edmondson
Affiliation:
Queen Elizabeth Hospital, Gateshead
Martin Gore
Affiliation:
Institute of Cancer Research, London
Iain A. McNeish
Affiliation:
Barts and The London School of Medicine, London
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Summary

Introduction

Over the past four decades, increased understanding of the pathophysiology and behaviour of gynaecological peritoneal surface malignancies has led to significant advances in effective treatment modalities. Numerous studies have shown that surgical cytoreduction of all visible tumour in the peritoneal cavity plays a crucial role in optimising survival from these diseases. Consequently, the surgical management of advanced ovarian, primary peritoneal and fallopian tube cancers has evolved from basic gynaecological oncology procedures (hysterectomy, salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node dissection) to the incorporation of more comprehensive surgical cytoreductive procedures as part of a maximal surgical effort. These extensive procedures often target peritoneal surfaces that involve multiple ‘non-gynaecological’ organs and sites such as the small intestine, colon, diaphragm, liver, porta hepatis, gall bladder, spleen, pancreas, stomach, coeliac axis, mediastinal lymph nodes and pleural cavity.

Individually, each of the procedures used in a maximal cytoreductive effort are performed by surgeons throughout the world. However, the performance of many if not all of the various upper abdominal and pelvic procedures in women with gynaecological malignancies is not necessarily done nor accepted internationally, and hence some refer to the combination of these procedures in individual women for cytoreductive purposes as ‘ultra-radical’. Unquestionably, these procedures require detailed knowledge of upper abdominal anatomy not generally taught in gynaecological oncology training programmes. Consequently, there is a potential for ‘non-gynaecological’ perioperative complications in addition to those that may be encountered in more standard gynaecological oncology surgery.

Type
Chapter
Information
Gynaecological Cancers
Biology and Therapeutics
, pp. 109 - 120
Publisher: Cambridge University Press
Print publication year: 2011

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