Introduction/Background En bloc pelvic resection including hysterectomy, bilateral salpingo-oophorectomy and rectosigmoid colon resection and anastomosis is often performed to achieve optimal cytoreduction in ovarian cancer patients with extensive pelvic carcinomatosis. We presented specific surgical details of total pelvic peritonectomy avoiding rectosigmoid colon resection in a well-selected patient.
Methodology A 41 year-old women with good performance status (ECOG 0) presented with disseminated disease in abdominal and pelvic cavity. The patient underwent primary debulking surgery including total pelvic peritonectomy. The procedure is initiated by accessing the retroperitoneum by incision of the anterior and lateral peritoneum. After retroperitoneum exposure, the round ligament, infundibulo-pelvic ligament, medial umbilical ligament, and umbilical artery are dissected and ligated. The bladder is mobilized caudally and the vesico-vaginal space is exposed after completely dissecting off the prevesical peritoneum. In the next step, the ureter is isolated and mobilized laterally. Then, uterine vessels and parametria are divided and ligated, which is followed by colpotomy to access the recto-vaginal septum. By retracting the total specimen cranially, the Douglas pouch is dissected from the anterior side of rectum. The mesorectum is further divided and dissected in the extraperitoneal space. The specimen is removed en bloc with the uterus, adnexa, pelvic peritoneum, and tumor nodules, leaving a tumor-invisible pelvis (figure 1). The sigmoid is also deperitonized.
Results Complete removal of the disseminated tumors in two layers of peritoneum (parietal and visceral) was achieved by the method introduced in our video.
Conclusion Total pelvic peritonectomy is effective for complete cytoreduction in selected ovarian cancer patients with extensive peritoneal carcinomatosis sparing rectosigmoid resection.
Disclosure Nothing to disclose
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