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Surgical management in the pelvis for patients with advanced ovarian cancer

  • Andrea Giannini1,2,*,
  • Kristina A. Butler1,*,

1Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, AZ 85054, USA

2Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy

DOI: 10.22514/ejgo.2022.003 Vol.43,Issue 3,June 2022 pp.9-24

Submitted: 28 December 2021 Accepted: 16 March 2022

Published: 15 June 2022

(This article belongs to the Special Issue Radical Surgery in Ovarian Cancer)

*Corresponding Author(s): Andrea Giannini E-mail: Giannini.Andrea@mayo.edu
*Corresponding Author(s): Kristina A. Butler E-mail: Butler.Kristina@mayo.edu

Abstract

In 70% of women, the diagnosis of epithelial ovarian cancer is at the advanced stage, and patient survival is negatively correlated with residual disease diameter in many series and meta-analyses. This evidence emphasizes the role of maximal cytoreduction in this particular oncologic population. In patients with disrupted pelvic anatomical conditions such as the so-called “frozen pelvis”, the surgeons are called to a significant effort to achieve the maximal cytoreduction. Unlike colorectal cancer, malignant ovarian cells tend to invade superficial abdominal surfaces disseminating within the peritoneal cavity, thus involving the peritoneum layer and the omentum in most cases. This different etiopathogenesis determines the possibility of resecting most superficial lesions by mesorectal or total peritoneal stripping, thus achieving optimal surgical outcomes. Radical surgeries to debulk high-stage ovarian cancer have been described since 1965, additionally; in the 1970s, Hudson published the rationale and the description of retrograde hysterectomy during a radical oophorectomy. During the last two decades, the technique of radical oophorectomy with en-bloc resection of rectosigmoid for the frozen pelvis has gained popularity, and different surgical steps have been standardized to ease replication and used for teaching purposes. Moreover, the reduction of bleeding and the oncologic effectiveness of this cytoreductive procedure fit well together with the concept of the complete multiorgan debulking required in advanced ovarian cancer. In this view, the use of this standardized radical surgery allows the safe and comprehensive removal of all pelvic cancer in patients with advanced ovarian disease. This manuscript is an extensive updated technical overview from the pioneering series of our retired mentors to the current evolving surgical breakthroughs. Nowadays, this complex exenterative surgery paradigm for the frozen pelvis in advanced ovarian cancer is still changing because the innovative biological, genetic knowledge is continuously growing and evolving parallel to the advanced perioperative, anesthesiologic, and radiologic care.


Keywords

Radical surgery; Epithelial ovarian cancer; Frozen pelvis; Radical oophorectomy


Cite and Share

Andrea Giannini,Kristina A. Butler. Surgical management in the pelvis for patients with advanced ovarian cancer. European Journal of Gynaecological Oncology. 2022. 43(3);9-24.

References

[1] Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, et al. Carcinoma of the fallopian tube. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. International Journal of Gynecology & Obstetrics. 2006; 95: S145–S160.

[2] du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials. Cancer. 2009; 115: 1234–1244.

[3] Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival Effect of Maximal Cytoreductive Surgery for Advanced Ovarian Carcinoma during the Platinum Era: a Meta-Analysis. Journal of Clinical Oncology. 2002; 20: 1248–1259.

[4] Chang S, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecologic Oncology. 2013; 130: 493–498.

[5] Eisenkop SM, Spirtos NM, Friedman RL, Lin WM, Pisani AL, Perticucci S. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecologic Oncology. 2003; 90: 390–396.

[6] Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Journal of the National Cancer Institute. Monographs. 1975; 42: 101–104.

[7] Hacker NF, Berek JS, Lagasse LD, Nieberg RK, Elashoff RM. Primary cytoreductive surgery for epithelial ovarian cancer. Obstetrics & Gynecology. 1983; 61: 413–420.

[8] Bertelsen K. Tumor reduction surgery and long-term survival in advanced ovarian cancer: a DACOVA study. Gynecologic Oncology. 1990; 38: 203–209.

[9] Winter WE, Maxwell GL, Tian C, Sundborg MJ, Rose GS, Rose PG, et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. Journal of Clinical Oncology. 2008; 26: 83–89.

[10] Horowitz NS, Miller A, Rungruang B, Richard SD, Rodriguez N, Bookman MA, et al. Does Aggressive Surgery Improve Outcomes?Interaction between Preoperative Disease Burden and Complex Surgery in Patients with Advanced-Stage Ovarian Cancer: an Analysis of GOG 182. Journal of Clinical Oncology. 2015; 33: 937–943.

[11] Chi DS, Eisenhauer EL, Zivanovic O, Sonoda Y, Abu-Rustum NR, Levine DA, et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecologic Oncology. 2009; 114: 26–31.

[12] Ataseven B, Grimm C, Harter P, Heitz F, Traut A, Prader S, et al. Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV. Gynecologic Oncology. 2016; 140: 215–220.

[13] Bristow RE, Chang J, Ziogas A, Campos B, Chavez LR, Anton-Culver H. Impact of National Cancer Institute Comprehensive Cancer Centers on ovarian cancer treatment and survival. Journal of the American College of Surgeons. 2015; 220: 940–950.

[14] Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer. New England Journal of Medicine. 2010; 363: 943–953.

[15] Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015; 386: 249–257.

[16] Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, et al. Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2021; 19: 191–226.

[17] Colombo N, Sessa C, du Bois A, Ledermann J, McCluggage WG, McNeish I, et al. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. Annals of Oncology. 2019; 30: 672–705.

[18] Ramirez PT. Standardizing ovarian cancer surgery and peri-operative care: a European Society of Gynecological Oncology (ESGO) consensus statement. International Journal of Gynecologic Cancer. 2021; 31: 1207–1208.

[19] Chang S, Bristow RE. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining ‘optimal’ residual disease. Gynecologic Oncology. 2012; 125: 483–492.

[20] Son J, Kim J, Shim J, Kong T, Paek J, Chang S, et al. Comparison of posterior rectal dissection techniques during rectosigmoid colon resection as part of cytoreductive surgery in patients with epithelial ovarian cancer: Close rectal dissection versus total mesorectal excision. Gynecologic Oncology. 2019; 153: 362–367.

[21] Hoffman MS, Griffin D, Tebes S, Cardosi RJ, Martino MA, Fiorica JV, et al. Sites of bowel resected to achieve optimal ovarian cancer cytoreduction: implications regarding surgical management. American Journal of Obstetrics and Gynecology. 2005; 193: 582–588.

[22] Lengyel E. Ovarian cancer development and metastasis. The American Journal of Pathology. 2010; 177: 1053–1064.

[23] Orosco RK, Tapia VJ, Califano JA, Clary B, Cohen EEW, Kane C, et al. Positive Surgical Margins in the 10 most Common Solid Cancers. Scientific Reports. 2018; 8: 5686.

[24] Barber HR, Brunschwig A. Pelvic exenteration for locally advanced and recurrent ovarian cancer. Review of 22 cases. Surgery. 1965; 58: 935–937.

[25] Hudson CN. A radical operation for fixed ovarian tumours. The Journal of Obstetrics and Gynaecology of the British Commonwealth. 1968; 75: 1155–1160.

[26] BRUNSCHWIG A. Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer. 2008; 1: 177–183.

[27] Hudson CN, Chir M. Surgical treatment of ovarian cancer. Gynecologic Oncology. 1973; 1: 370–378.

[28] Clayton RD, Obermair A, Hammond IG, Leung YC, McCartney AJ. The Western Australian experience of the use of en bloc resection of ovarian cancer with concomitant rectosigmoid colectomy. Gynecologic Oncology. 2002; 84: 53–57.

[29] Berek JS, Hacker NF, Lagasse LD. Rectosigmoid colectomy and reanastomosis to facilitate resection of primary and recurrent gynecologic cancer. Obstetrics and Gynecology. 1984; 64: 715–720.

[30] Soper JT, Couchman G, Berchuck A, Clarke-Pearson D. The role of partial sigmoid colectomy for debulking epithelial ovarian carcinoma. Gynecologic Oncology. 1991; 41: 239–244.

[31] Obermair A, Hagenauer S, Tamandl D, Clayton RD, Nicklin JL, Perrin LC, et al. Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer. Gynecologic Oncology. 2001; 83: 115–120.

[32] Bridges JE, Leung Y, Hammond IG, McCartney AJ. En bloc resection of epithelial ovarian tumors with concomitant rectosigmoid colectomy: the KEMH experience. International Journal of Gynecological Cancer. 2013; 3: 199–202.

[33] Barnes W, Johnson J, Waggoner S, Barter J, Potkul R, Delgado G. Reverse hysterocolposigmoidectomy (RHCS) for resection of panpelvic tumors. Gynecologic Oncology. 1991; 42: 151–155.

[34] Sugarbaker PH. Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent ovarian cancer. Cancer Treatment and Research. 1996; 81: 75–87.

[35] Sainz de la Cuesta R, Goodman A, Halverson SS. En bloc pelvic peritoneal resection of the intraperitoneal pelvic viscera in patients with advanced epithelial ovarian cancer. The Cancer Journal from Scientific American. 2006; 2: 152–157.

[36] Eisenkop SM, Nalick RH, Teng NN. Modified posterior exenteration for ovarian cancer. Obstetrics and Gynecology. 1991; 78: 879–885.

[37] Vizzielli G, Chiantera V, Tinelli G, Fagotti A, Gallotta V, Di Giorgio A, et al. Out-of-the-box pelvic surgery including iliopsoas resection for recurrent gynecological malignancies: does that make sense? a single-institution case-series. European Journal of Surgical Oncology. 2017; 43: 710–716.

[38] Vanderpuye VD, Clemenceau JRV, Temin S, Aziz Z, Burke WM, Cevallos NL, et al. Assessment of Adult Women with Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline. JCO Global Oncology. 2021; 3: 1032–1066.

[39] Salani R, Bristow RE. Surgical management of epithelial ovarian cancer. Clinical Obstetrics and Gynecology. 2012; 55: 75–95.

[40] van de Vrie R, Rutten MJ, Asseler JD, Leeflang MM, Kenter GG, Mol BWJ, et al. Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer. Cochrane Database of Systematic Reviews. 2019; 3: CD009786.

[41] Fagotti A, Ferrandina G, Fanfani F, Garganese G, Vizzielli G, Carone V, et al. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. American Journal of Obstetrics and Gynecology. 2008; 199: 642.e1–642.e6.

[42] Chi DS, Musa F, Dao F, Zivanovic O, Sonoda Y, Leitao MM, et al. An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). Gynecologic Oncology. 2012; 124: 10–14.

[43] Grimes WR, Stratton M. Pelvic Exenteration. 2021 Oct 9. In StatPearls. StatPearls Publishing: Treasure Island (FL). 2022.

[44] Cao F, Li J, Li F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. International Journal of Colorectal Disease. 2012; 27: 803–810.

[45] Dolejs SC, Guzman MJ, Fajardo AD, Robb BW, Holcomb BK, Zarzaur BL, et al. Bowel Preparation is Associated with Reduced Morbidity in Elderly Patients Undergoing Elective Colectomy. Journal of Gastrointestinal Surgery. 2017; 21: 372–379.

[46] Atkinson SJ, Swenson BR, Hanseman DJ, Midura EF, Davis BR, Rafferty JF, et al. In the Absence of a Mechanical Bowel Prep, does the Addition of Pre-Operative Oral Antibiotics to Parental Antibiotics Decrease the Incidence of Surgical Site Infection after Elective Segmental Colectomy?Surgical Infections. 2015; 16: 728–732.

[47] Dowdy SC. Enhanced recovery after surgery for ovarian cancer. Clinical Advances in Hematology & Oncology. 2019; 17: 217–219.

[48] Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World Journal of Surgery. 2019; 43: 659–695.

[49] Kalogera E, Van Houten HK, Sangaralingham LR, Borah BJ, Dowdy SC. Use of bowel preparation does not reduce postoperative infectious mor-bidity following minimally invasive or open hysterectomies. American Journal of Obstetrics and Gynecology. 2020; 223: 231.e1–231.e12.

[50] Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database of Systematic Reviews. 2009; (1): CD001181.

[51] Carter J, Chi DS, Abu-Rustum N, Brown CL, McCreath W, Barakat RR. Brief report: Total pelvic exenteration-a retrospective clinical needs assessment. Psycho-Oncology. 2004; 13: 125–131.

[52] Bristow RE, del Carmen MG, Kaufman HS, Montz FJ. Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. Journal of the American College of Surgeons. 2003; 197: 565–574.

[53] Sugarbaker PH. Peritonectomy procedures. Surgical Oncology Clinics of North America. 2003; 12: 703–27, xiii.

[54] Kim M, Noh JJ, Lee Y. En bloc pelvic resection of ovarian cancer with rectosigmoid colectomy: a literature review. Gland Surgery. 2021; 10: 1195–1206.

[55] Warton B. Technical advances in treatment of gynaecological malignancy. Australian Family Physician. 1983; 12: 413–414, 416.

[56] Magrina JF. Types of pelvic exenterations: a reappraisal. Gynecologic Oncology. 1990; 37: 363–366.

[57] Magrina JF, Stanhope CR, Weaver AL. Pelvic Exenterations: Suprale-vator, Infralevator, and with Vulvectomy. Gynecologic Oncology. 1997; 64: 130–135.

[58] Gillette-Cloven N, Burger RA, Monk BJ, McMeekin DS, Vasilev S, DiSaia PJ, et al. Bowel resection at the time of primary cytoreduction for epithelial ovarian cancer. Journal of the American College of Surgeons. 2001; 193: 626–632.

[59] Hertel H, Diebolder H, Herrmann J, Köhler C, Kühne-Heid R, Possover M, et al. Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer. Gynecologic Oncology. 2001; 83: 481–484.

[60] Kim M, Suh DH, Park JY, Paik ES, Lee S, Eoh KJ, et al. Survival impact of low anterior resection in patients with epithelial ovarian cancer grossly confined to the pelvic cavity: a Korean multicenter study. Journal of Gynecologic Oncology. 2018; 29: e60.

[61] Mourton SM, Temple LK, Abu-Rustum NR, Gemignani ML, Sonoda Y, Bochner BH, et al. Morbidity of rectosigmoid resection and primary anastomosis in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer. Gynecologic Oncology. 2005; 99: 608–614.

[62] Park J, Seo S, Kang S, Lee KB, Lim SY, Choi HS, et al. The benefits of low anterior en bloc resection as part of cytoreductive surgery for advanced primary and recurrent epithelial ovarian cancer patients outweigh morbidity concerns. Gynecologic Oncology. 2006; 103: 977–984.

[63] Aletti GD, Podratz KC, Jones MB, Cliby WA. Role of rectosigmoidec-tomy and stripping of pelvic peritoneum in outcomes of patients with advanced ovarian cancer. Journal of the American College of Surgeons. 2006; 203: 521–526.

[64] Sznurkowski JJ. En bloc pelvic resection for advanced ovarian cancer preceded by central ligation of vessels supplying the tumor bed: a description of surgical technique and a feasibility study. World Journal of Surgical Oncology. 2016; 14: 133.

[65] Tozzi R, Hardern K, Gubbala K, Garruto Campanile R, Soleymani majd H. En-bloc resection of the pelvis (EnBRP) in patients with stage IIIC–IV ovarian cancer: a 10 steps standardised technique. Surgical and survival outcomes of primary vs. interval surgery. Gynecologic Oncology. 2017; 144: 564–570.

[66] Tozzi R, Gubbala K, majd HS, Campanile RG. Interval Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) in patients with stage IIIC-IV ovarian cancer: Description of the technique and surgical outcomes. Gynecologic Oncology. 2016; 142: 477–483.

[67] Kato K, Omi M, Fusegi A, Takeshima N. Modified posterior pelvic exenteration with pelvic side-wall resection requiring both intestinal and urinary reconstruction during surgery for ovarian cancer. Gynecologic Oncology. 2019; 155: 172–173.

[68] Chang SJ, Bristow RE. Surgical technique of en bloc pelvic resection for advanced ovarian cancer. Journal of Gynecologic Oncology. 2015; 26: 155.

[69] Kim HS, Bristow RE, Chang S. Total parietal peritonectomy with en bloc pelvic resection for advanced ovarian cancer with peritoneal carcinomatosis. Gynecologic Oncology. 2016; 143: 688–689.

[70] Muallem MZ, Sehouli J, Miranda A, Richter R, Muallem J. Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation): a novel surgical technique for advanced ovarian cancer. International Journal of Gynecological Cancer. 2020; 30: 648–653.

[71] Khatib G, Guzel AB, Gulec UK, Vardar MA. A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Çukurova technique). Gynecologic Oncology. 2017; 146: 674–675.

[72] Khatib G, Seyfettinoglu S, Guzel AB, Gulec UK, Unlugenc H, Vardar MA. Feasibility and rationale of a novel approach in advanced ovarian cancer surgery: Bat- shaped en-bloc total peritonectomy and total hysterectomy salpingo-oophorectomy with or without rectosigmoid resection (Sarta-Bat approach). Gynecologic Oncology. 2021; 161: 97–103.

[73] Höckel M. Long-term experience with (laterally) extended endopelvic resection (LEER) in relapsed pelvic malignancies. Current Oncology Reports. 2015; 17: 435.

[74] Andikyan V, Khoury-Collado F, Sonoda Y, Gerst SR, Alektiar KM, Sandhu JS, et al. Extended pelvic resections for recurrent or persistent uterine and cervical malignancies: an update on out of the box surgery. Gynecologic Oncology. 2012; 125: 404–408.

[75] Vizzielli G, Naik R, Dostalek L, Bizzarri N, Kucukmetin A, Tinelli G, et al. Laterally Extended Pelvic Resection for Gynaecological Malignancies: a Multicentric Experience with out-of-the-Box Surgery. Annals of Surgical Oncology. 2019; 26: 523–530.

[76] Zanagnolo V, Garbi A, Achilarre MT, Minig L. Robot-assisted Surgery in Gynecologic Cancers. Journal of Minimally Invasive Gynecology. 2017; 24: 379–396.

[77] Magrina JF, Zanagnolo V, Noble BN, Kho RM, Magtibay P. Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy. Gynecologic Oncology. 2011; 121: 100–105.

[78] Magrina JF, Magtibay PM. Robotic Resection of Diaphragm Metastases in Ovarian Cancer: Technical Aspects. Journal of Minimally Invasive Gynecology. 2020; 27: 1417–1422.

[79] Mutlu L, Khadraoui W, Khader T, Menderes G. Robotic Tumor Debulking off External Iliac Vessels for the Management of Recurrent Ovarian Cancer. Journal of Minimally Invasive Gynecology. 2020; 27: 1021–1022.

[80] Aletti GD, Santillan A, Eisenhauer EL, Hu J, Aletti G, Podratz KC, et al. A new frontier for quality of care in gynecologic oncology surgery: multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. Gynecologic Oncology. 2007; 107: 99–106.

[81] Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. British Medical Journal. 2001; 323: 773–776.

[82] Tozzi R, Casarin J, Garruto-Campanile R, Majd HS, Morotti M. Morbidity and reversal rate of ileostomy after bowel resection during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer. Gynecologic Oncology. 2018; 148: 74–78.

[83] Kalogera E, Dowdy SC, Mariani A, Weaver AL, Aletti G, Bakkum-Gamez JN, et al. Multiple large bowel resections: potential risk factor for anastomotic leak. Gynecologic Oncology. 2013; 130: 213–218.


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