The principles of safe and efficacious upper abdominal surgery

Abstract

: Upper abdominal debulking procedures represent an indispensable part of cytoreduction for advanced ovarian cancer. As a genuinely peritoneally disseminated malignancy, more than 70% of the patients will present in an advanced stage with tumor involvement of the upper abdominal organs, especially liver-and splenic capsule, lesser sac, Morrisons pouch and diaphragm. Studies have clearly shown the maximal survival benefit being derived from maximal effort surgery achieving total macroscopic tumor clearance. For that reason, gynecological oncology teams need to master the dissection techniques in the upper abdomen and also be able to handle the associated complications. We will review here the key issues around upper abdominal cytoreduction and focus on the spleen, liver, and stomach/lesser sac. Diaphragmatic surgery will be addressed in a separate, especially dedicated chapter. Safety and feasibility of complex oncologic upper abdominal dissections for advanced and relapsed ovarian cancer are based on the fundamental knowledge of anatomy, principles of peritonectomy techniques, as well as infrastructural support and collective knowledge and education of the entire team. Surgical and infrastructural expertise are of paramount importance to achieve best possible oncologic outcomes with an acceptable morbidity profile even for those patients with high burden disease.