Introduction/Background Approximately 75% of patients diagnosed with ovarian cancer present with advanced stage disease. This may include upper abdominal sites such as the liver, spleen, diaphragm, and upper abdominal lymph nodes. Complete macroscopic cytoreduction should be the goal in ovarian surgery, therefore upper abdominal resections may be an integral surgical component in this setting. We aimed to evaluate upper abdominal interventions in all ovarian cytoreductions performed in our cancer centre.
Methodology We performed a retrospective observational study on a cohort of 253 patients that underwent primary (PCS) interval (ICS) and delayed (DCS) cytoreduction surgery for presumed or confirmed ovarian cancer between 2020 and 2022. Collected data included demographics, tumor histology subtype, and stage at diagnosis. Surgical resection status and upper abdominal resection sites were evaluated to establish the prevalence of upper abdominal interventions. Descriptive statistics were performed on Microsoft Excel.
Results The patients’ mean age at diagnosis was 58.8 years (range 22–93). High grade serous (59.3%), clear cell carcinoma (8.7%) and endometrioid (8.3%) were the three most prevalent histological subtypes. Advanced disease (Stage lll-IVB) was present in 58.1% of patients. PCS was performed in 57.3%, ICS in 31.6% and DCS in 11.1% of patients. R0 resection rates were 93.1% in PCS, 78.8% in ICS and 54.2% in DCS. In patients with advanced disease, upper abdominal resection was required in 39.6% undergoing PCS, 38.8% undergoing ICS and 28.6% undergoing DCS, translating into an overall rate of 39.5%. Right diaphragmatic stripping or full thickness resection (29.3%), splenectomy (7.5%), lesser sac disease resection (5.4%) and porta-hepatis disease resection (5.4%) were the most common interventions.
Conclusion The proportion of patients with advanced-stage disease requiring upper abdominal resections is 39.5%. Appropriate pre-operative counseling highlighting the possible need for such procedures is recommended. Surgical training should ensure competency in performing upper abdominal resections.
Disclosures The authors declare no conflict of interest.
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