Introduction/Background*The combination of emerging target therapies and continuous technological advancement in surgical procedures support a trend toward a prolonged survival in advanced ovarian cancer (AOC) patients. Upper abdominal carcinomatosis hides challenging locations for complete gross resection in the hands of expert gynecologic oncologists. We developed an anatomo-surgical classification for ovarian cancer metastases in the liver area from a gynecological point of view, aiming to provide an anatomo-topographical tool to address each surgical task and to standardize the nomenclature in the radiological and surgical report.
Methodology After the identification of four conceptually distinct anatomical areas, we used both the three-dimensional anatomical model and the surgical video report to represent them individually.
Result(s)*Our anatomo-surgical classification is divided into 4 distinct categories:
TYPE1 GLISSON’S CAPSULE: superficial metastases involving only the Glisson’s sheat with no parenchymal infiltration (either focal or extensive).
TYPE2 LIGAMENTOUS: this is a heterogeneous group defining cancer deposits along the lines of reflection between the liver and surrounding organs. We can further divide it into ‘falciform ligament’, ‘round ligament’, ‘Arantii and hepato-gastric ligament’, ‘coronary and triangular ligament’ localizations.
TYPE3 HEPATIC HILUM: the porta hepatis is considered as a single entity due to its potentially dual neoplastic involvement both peritoneal or ‘external’ as hepato-duodenal ligament and lymphatic or ‘internal’ while involving lymph-nodes along the portal triad.
TYPE4 PARENCHYMAL: we identified, based on surgical management, the ‘superficial’ intra-parenchymal localization, infiltrating the less than 1 cm in depth, and the fully intra-parenchymal.
Conclusion*Our classification represents a useful guide while planning the surgical strategy to AOC metastases in the liver area.
Identification of each category, specific underlining anatomical pitfalls and its surgical-related management, guarantees a didactic and effective tool in supporting the daily intraoperative decision-making algorithm, and in assigning the specific procedure within a multidisciplinary team, based on surgical competence.
Furthermore, the standardization of nomenclature allows an easy exchange of surgical information for scientific purposes, that are otherwise difficult to interpret and compare.
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