Oncology and Fibroids
In surgical staging of ovarian Ca, all are done except: (AIPG 2009)
|D||Palpation of organs|
1. The treatment of ovarian cancer is to do a staging laparotomy and an optimal de bulking (cyto reduction) surgery.
2. The staging laparotomy requires a vertical incision of sufficient length to ensure adequate examination of the abdominal contents.
3. The presence, amount, and cytology of any ascitic fluid should be noted. The primary tumor should be evaluated for rupture, excrescences, or dense adherence.
4. Careful visual and manual inspection of the diaphragm and peritoneal surfaces is required.
5. A partial omentectomy should be performed and the paracolic gutters inspected. Pelvic lymph nodes as well as para-aortic nodes in the region of the renal hilus should be biopsied.
6. If there is no visible disease outside of an ovary
a. Aspirate ascitic fluid for cytology studies.
b. Perform peritoneal washings* for cytology if ascites is not present.
c. Remove the ovary and ovarian tumor intact.
d. Perform diaphragmatic scraping or biopsy for cytology studies.
e. Obtain peritoneal biopsy specimens.
f. Perform a subcolic omentectomy.
g. Obtain bilateral para-aortic and pelvic node samples.
h. Obtain biopsy samples of adhesions or other suspicious areas.
i. If the patient does not desire future fertility, perform a total abdominal hysterectomy and excise the opposite ovary.
j. Remove the appendix if mucinous tumor is present.
7. Macroscopic disease outside of the ovary
a. All visible tumor should be removed. This may require extensive surgery, including bowel resection, excision of peritoneal implants, liver resection, omentectomy, and splenectomy.
b. The extent of bowel resection should depend on the role this plays in achieving maximal cytoreduction.