ABSTRACT

The rate of optimal cytoreduction varies between institutions, and to some degree depends on specialty training, philosophy, and surgical aggressiveness. 17,18 It is essential that the surgeon is able to make a reasonable judgment as to the feasibility that any aggressive procedure will lead to optimal cytoreduction. The surgical morbidities must always be considered. Most often for the gynecologic oncologist, the extent of upper abdominal disease and bowel/ mesenteric involvement may limit the ability to perform optimal cytoreduction. Aggressive attempts at tumor resection may require radical hysterectomy, omentectomy, resection of either small or large intestine, splenectomy, diaphragmatic peritonectomy, hepatic resection, or other related procedures. Splenectomy, diaphragmatic peritonectomy, and hepatectomy, as well as the elimination of peritoneal implants, can be safely performed in carefully selected patients with upper abdominal disease. 11,17,19-21 These procedures should be considered if they would result in an optimal cytoreduction, since patients with optimally resected upper abdominal disease have similar outcomes to other patients who are optimally cytoreduced. 22 Bowel resection is often necessary, is safe to perform, and will offer a survival benefit if the end result is optimal cytoreduction. 9,23 Ovarian cancer rarely progresses below the pelvic peritoneal reflection and therefore it is possible to safely perform low colorectal anastomoses in the majority of cases. 23

to be in the upper abdomen and radical pelvic surgery is unlikely. More commonly, radical pelvic and colorectal surgery must be anticipated, and the patient should be placed in the low lithotomy position. The skin should be antiseptically prepared from the breasts to the mid-thigh and perineum. A Foley catheter is placed in the urinary bladder. All patients undergoing abdominal or pelvic surgery for gynecologic cancer should have pneumatic compression devices placed on the calves prior to the induction of anesthesia and should receive postoperative deep venous thrombosis prophylaxis with subcutaneous low-molecular-weight or unfractionated heparin.