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Removal of extensive pelvic and abdominal tumors

General

This operation is performed either as primary treatment before chemotherapy or after the patient has been given 3 to 4 cycles of chemotherapy (interval debulking).

The extensiveness of the operation can vary greatly, all depending on the extent of the tumor masses. 

With an extensive tumor in the pelvis, it is often necessary to remove the uterus and adnexa and resect part of the recto-sigmoid en bloc. A recto-sigmoid anastomosis can then be performed (low anterior resection). It may be necessary to resect parts of the intestinal system. If the spleen in infiltrated, this can be removed, as well as in extirpation of a single liver metastasis. Extensive resections or removal of the spleen will normally not be performed if there will be remaining macroscopic tumor after the operation. The patient should be prepared for a possible intestinal operation, and antibiotic prophylaxis should be given. The appendix should be removed in the case of mucinous tumors (only ovarian cancer) and when it is infiltrated by tumor or traumatized.   

A mid-line incision should always be used with suspicion of extensive pelvic and abdominal tumors. The operation is started by aspirating ascites for cytological examination. If there are no ascites, the cavity should be rinsed with 50 ml sterile water, which is sent for cytological examination. A thorough inspection of the pelvis and upper abdomen, including the diaphragm with description of size and localization of tumor changes, is done. Any adherences should be described as well as any possible rupture of tumor pre- or intraoperatively. 

If all intraabdominal and pelvic tumor tissue is successfully removed, the pelvic and paraaortal lymph nodes are removed. It is sometimes necessary to perform a partial or complete peritonectomy and/or diaphragm resection to remove all tumor tissue.

Indications

  • Advanced ovarian cancer
  • Fallopian tube cancer

Goal

  • As much of the tumor should be removed as possible.
  • The operation is also intended to map the extent of the tumor and to remove a specimen of tumor for histological examination.  

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