| Abstract: |
Indications for Omentectomy and Intestinal Resection Omentectomy is typically performed at initial surgery since it is a routine part of the staging procedure for this disease and since the omentum is a common site of tumor implantation due to its high fat content and rich blood supply. In the usual case of advanced-stage ovarian cancer, innumerable omental tumor implants coalesce into a bulky tumor mass-the so-called omental cake-the removal of which is an integral component to optimal cytoreductive surgery. There are two main indications for performing an intestinal resection for ovarian cancer: (i) to achieve an optimal volume of residual disease and (ii) to relieve obstruction. The management of bowel obstruction is addressed in chapter 13. Intestinal resection performed as part of tumor-reductive surgery is by far the most common indication for bowel resection at time of primary ovarian cancer surgery (9). The concept of “optimal” cytoreduction stems from Griffiths sentinel paper, which was the first to conclusively demonstrate a survival advantage for patients left with small-volume residual disease (10). Although some have questioned the impact of bowel resection on survival in patients with ovarian cancer, the survival advantage after optimal debulking appears to be evident despite the fact that patients require a bowel resection (9,11,12). The Mayo Clinic experience with gastrointestinal surgery performed on patients with ovarian cancer, reported by Tamussino et al., is representative of the body of literature on this topic (13). At primary surgery, tumor cytoreduction was the indication for 87% of bowel resections; the remaining resections were performed for bowel obstruction. The most common complications were febrile morbidity and ileus, which occurred in 28% and 21% of cases, respectively. Anastomotic leak and abscess requiring laparotomy each occurred in less than 1% of patients. In general, approximately 20% of patients undergoing initial cytoreductive surgery for ovarian cancer will require an extrapelvic bowel resection (14). © 2010 Informa Healthcare, except as otherwise indicated. |
