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Modified posterior exenteration in ovarian cancer treatment

Łukasz Wicherek1,2, Jerzy Kuśnierz3,Beata Śpiewankiewicz3

Affiliacja i adres do korespondencji
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 125–136
DOI: 10.15557/CGO.2013.0012
Streszczenie

The treatment of ovarian cancer is a type of combination treatment consisting of surgery and chemotherapy. Based on numerous studies, one might conclude that the radical nature of the surgical treatment is critical to the survival of the ovarian cancer patient. The aim of the primary procedure is complete cytoreduction, meaning the removal of all macroscopic foci of the cancer. This can be challenging since infiltration of the cancer frequently goes beyond the reproductive organs into the pelvis, involving the rectum, sigmoid colon, and the peritoneum of the lower recess. Therefore, apart from standard procedures, modified posterior exenteration (MPE) should be performed. MPE allows for en bloc resection of the cancerous tumor together with the uterus, adnexa, and parametria, and portions of the vagina, the pelvic peritoneum, the anterior aspect of the rectum, and the sigmoid colon. The next stage of the procedure is colostomy or anastomosis within the region of the gastrointestinal tract followed by lymphadenectomy. A natural consequence of such an extensive intervention is a substantial number of complications. These, however, do not affect the quality of life of patients with ovarian cancer in an appreciable manner and thus have been accepted among gynecologic oncologists. What is important is that this type of surgery has a positive influence on prognosis, tending to prolong patients’ lives. Even when complications do occur, it is still more valuable to go ahead with this type of treatment than to forgo it in the interests of trying to avoid any possible negative consequences. This decision seems even more valid when the progress of medicine, which has enabled the effective treatment of such complications, is taken into consideration. The most common consequences of such a procedure are infection and wound dehiscence while anastomotic dehiscence within the gastrointestinal tract rarely occurs. The data included in the literature has clearly demonstrated that the patient’s preoperative serum albumin level may be connected with the risk of these common consequences and that the experience of the gynecologic oncologist who performs the procedure substantially influences whether such complications occur. It is therefore crucial that we create a nationwide chain of oncologic hospitals where these types of combination treatments of malignant neoplasms can be successfully carried out.

Słowa kluczowe
ovarian carcinoma, surgical treatment, modified posterior exenteration, rectosigmoid resection, perioperative complications