Paul H Sugarbaker
Title: A surgical perspective on the management of ovarian cancer: A video presentation
Biography
Biography: Paul H Sugarbaker
Abstract
Background: Many unknowns exist in the optimal management of ovarian cancer. However, one management strategy that has been
accepted as the best treatment is surgical removal of all or nearly all the visible evidence of disease within the abdomen and pelvis.
Th is may occur as a primary cytoreduction before other treatments are initiated or as an interval cytoreduction aft er neoadjuvant
chemotherapy has been completed. At both of these time points complete surgical removal is always the goal of optimal treatment.
Th is extensive surgery must occur in the absence of serious complications which would delay the other crucial treatment modality
which is chemotherapy with cisplatinum and paclitaxel.
Materials & Methods: Th rough a long midline abdominal incision, the abdomen and pelvis are widely exposed using skin traction
sutures followed by a self-retaining retractor. Peritonectomy procedures and visceral resections are used to remove diseased organs
that are layered by cancer. Aft er chemotherapy washing, a reconstruction of the gastrointestinal tract occurs.
Results: With the wide exposure, dissections proceed using ball-tip electrosurgery so that peritoneal surfaces layered by cancer can
be completely removed in the absence of blood loss. Also, dissection techniques for greater omentectomy allow a rapid and bloodless
removal of this organ which is heavily involved by the infi ltration of ovarian cancer. Peritonectomy of the right upper quadrant,
left upper quadrant, and both paracolic sulci proceed under direct vision. Pelvic peritonectomy is combined with hysterectomy,
oophorectomy, and left colectomy to extirpate large volumes of disease from the lower abdomen and pelvis. Hyperthermic
intraperitoneal chemotherapy (HIPEC) is administered using cisplatinum, doxorubicin and systemic ifosfamide for 90 minutes at
42°C. Intestinal anastomoses and then abdominal wall reconstruction proceed aft er the HIPEC. An intraperitoneal port is placed
in order to facilitate long-term normothermic intraperitoneal chemotherapy (NIPEC).
Conclusions: Th e goal of complete or near-complete removal of ovarian cancer which optimizes the initial treatment of this disease
can be accomplished through cytoreductive surgery. Th is requires a long midline abdominal incision for wide exposure of the
contents of the abdomen and pelvis, meticulous hemostasis and a plan of management that involves peritonectomy procedures,
visceral resections and HIPEC.