Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer-Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction

Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60-70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer survival compared, complete cytoreduction benefits overall survival, making upper-abdominal cytoreduction an essential component of CRS for advanced ovarian cancer. The upper abdomen constitutes several vital organs and large blood vessels draped with the parietal or visceral peritoneum, common sites of disease in ovarian cancer. A surgeon treating advanced ovarian cancer should be well versed in upper-abdominal cytoreduction techniques, including diaphragmatic peritonectomy and diaphragm resection, lesser omentectomy, splenectomy with or without distal pancreatectomy, liver resection, cholecystectomy, and suprarenal retroperitoneal lymphadenectomy. Other procedures such as clearance of the periportal region, Glisson's capsulectomy, clearance of the superior recess of the lesser sac, and Morrison's pouch are essential as these regions are often involved in ovarian cancer. This manuscript covers the surgical anatomy of the upper abdomen, the techniques and therapeutic rationale of upper-abdominal cytoreduction, and specific measures for perioperative management of these patients. The main focus is the description of various peritonectomies and regional lymphadenectomies.

Automated summary

Cytoreductive surgery (CRS) is essential for treating advanced ovarian cancer, particularly in cases with involvement in the upper abdomen. Surgeons should be skilled in techniques such as diaphragmatic peritonectomy, liver resection, and lymphadenectomy for optimal cytoreduction. This manuscript provides a comprehensive overview of the surgical anatomy, techniques, and perioperative management for upper-abdominal cytoreduction.