ABSTRACT
INTRODUCTION Ovarian cancer frequently involves the structures of the right upper abdomen. This is not surprising given the high incidence of extrapelvic disease among patients with primary ovarian malignancies and the typical pattern of peritoneal tumor dissemination along the right paracolic gutter to the right upper quadrant. At the time of primary cytoreductive surgery, the right hemidiaphragm and liver surface are often noted to harbor metastatic disease in patients with advanced-stage ovarian cancer (1-3). Less commonly, the liver parenchyma, gall bladder and its associated fossa, and porta hepatis may be involved with disease. Ovarian cancer recurrence may also manifest at these sites, particularly after an incomplete primary resection. Recent studies have specifically addressed the feasibility and survival benefit of radical resection of synchronous and metachronous lesions in the right upper quadrant (1,4-6). Nevertheless, ovarian cancer metastases involving the diaphragm, liver, and associated structures are frequently cited as principal impediments to achieving an overall optimal cytoreductive surgical outcome. Safe and effective operative management of such disease requires the ovarian cancer surgeon to be intimately familiar with the anatomy of the right upper quadrant and proficient in both excisional and ablative techniques of tumor extirpation.
