Upper abdominal debulking surgery for ovarian cancer total colectomy, total peritonectomy, and extended upper abdominal debulking surgery

Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery

“…However, fluid accumulation occurs in the pouch due to gravity, as it is one of the posterior spaces in the peritoneal cavity. For this reason, Morison's pouch is one of the most affected anatomical zones in AEOC [9,[53][54][55]. It is also a frequent site for OC recurrences [55].…”

“…Suboptimal cytoreduction often arises from the neglect of potential anatomical sites predisposed to concealing macroscopic tumor residues, often left unexplored during AEOC surgery [8]. Omitting dissection of these particular areas can compromise complete cytoreduction [9]. Anatomical sites that may harbor "neglected" tumor residues include the omental bursa; Morison's pouch; the base of the round ligament of the liver and hepatic bridge; the splenic hilum; and suprarenal, retrocrural, cardiophrenic and inguinal lymph nodes [3,5,7].…”

“…Anatomical sites that may harbor "neglected" tumor residues include the omental bursa; Morison's pouch; the base of the round ligament of the liver and hepatic bridge; the splenic hilum; and suprarenal, retrocrural, cardiophrenic and inguinal lymph nodes [3,5,7]. A profound understanding of anatomy is a prerequisite since in most cases the surgeon has to perform steps like liver mobilization, diaphragmatic peritonectomy and splenectomy, as well as dissection of suprarenal, celiac and cardiophrenic lymph nodes [9]. Consequently, oncogynecologists are responsible for the safe, precise and complete dissection of these anatomical areas.…”

Surgical Anatomy of the Liver—Significance in Ovarian Cancer Surgery

“…Ovarian cancer is the leading cause of death among all gynecological malignancies. Most patients present with an advanced stage of the disease [1,2]. The routes of spread in ovarian cancer include peritoneal dissemination, direct invasion, and lymphatic or hematogenous spread, with peritoneal and lymphatic spread being the most common among them [3].…”

“…The flow direction of the peritoneal fluid makes Diagnostics 2023, 13, 2371 2 of 31 the right subphrenic space a target site for peritoneal metastases, and the most frequently affected anatomical area in advanced cases is the right upper quadrant [4,5]. Involvement of the right diaphragm is observed in 40% to 70% of cases [1][2][3][4][5][6]. Nevertheless, the disease could also affect Morrison's pouch, the liver surface, or porta hepatis [6].…”