Introduction/Background Optimal and maximal debulking surgery is the gold standard treatment for advanced stage (Stage II and III) epithelial ovarian cancer patients (AOC). In patients with disease confined to pelvis, Hudson hsyterectomy with retroperitoneal retrograde approach is a way to completely excise tumor confined to lower abdominal region. Moreover extensive upper abdominal surgical procedures are obligatory in order to achieve R0 tumor status.
Methodology Between February 2017 -march 2019, 25 AOC patients operated in Akdeniz University, Department of Gynecology were retrospectively evaluated. All the patients underwent diagnostic laparoscopy and were evaluated for resectability (modified Fagotti score). When resectable, a wide midline incision was carried out. Then the liver was mobilized and upper abdominal procedures was performed. Then for pelvic disease, all retroperitoneal spaced was created, ureters were mobilised and the pelvic tumor was excised en bloc along with total pelvic pertioneum. When required rectosigmoid excision was perfromed. Intraoperative and postoperative parameters and short-term follow-up of 25 advanced stage ovarian cancer patients were analyzed.
Results Seven patients were subjected to neo-adjuvant chemo. Optimal debulking was achieved in 16 patients out of 18 primary debulked patients. In five patients rectosigmoid excision, in seven 7 diaphragma stripping, in two patients celiac truncus lymphadenectomy were performed. Mean operation time was 390 min (300–460 min). Median blood loss was 400 cc (200–800 cc). Postoperatively 2 patient experienced eviceration and were re-operated. Three patients had wound breakdown. One patient had pulmonary embolus. In four patients post-operative ileus was observed which was handled conservativelyMedian follow-up time was 16 months (3–23 months). Two patients experienced recurrences both of which were treated with second-line chemo.
Conclusion In patients with AOC extensive upper abdominal surgery and retrograde Hudson hsyterectomy are all feasible surgical options in order to eradicate peritoneal tumor with acceptable morbidty rates.
Disclosure Nothing to disclose.
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