Highlights:
-
•
Residual disease at the time of surgery remains one of the most important prognostic factors in advanced ovarian cancer.
-
•
Small bowel disease either serosal but also mesenteric, can negatively affect the ability of the surgical team to achieve complete gross resection.
-
•
Using a Veress needle and regular insufflation as tools to resect the small bowel mesentery.
-
•
HIPEC is being increasingly used as a tool at the time of Interval Cytoreductive Surgery.
Keywords: Mesenteric stripping, Veress needle, Cytoreductive Surgery
Abstract
Small bowel involvement in patients with advanced ovarian cancer has been associated with a worse prognosis and recent data suggests it can be an independent factor associated with shorter disease-free interval (Casales Campos et al., 2022). In the upfront cytoreductive setting, small bowel residual disease (serosa and mesentery) has been identified as the most common site of residual disease (Heitz et al., 2016). The morbidity associated with multiple small bowel resections and the length of the remaining small bowel constitute major limiting factors. As the surgical armamentarium of the gynecologic oncologist has considerably broaden to include more radical procedures, addressing miliary small bowel disease remains extremely important in the quest to achieve complete gross resection (CGR) and thus improving the overall prognosis (Jurado and Chiva, 2021). We present a case of a patient with stage IIIC high grade serous ovarian carcinoma that already had started neoadjuvant chemotherapy before presenting for surgical options. After 4 cycles of carboplatin and paclitaxel, the patient was offered interval cytoreductive surgery plus HIPEC with cisplatin. During surgical exploration, miliary small bowel mesenteric disease was noted but with a grossly intact jejunoileal serosa. The patient underwent bilateral diaphragmatic stripping, cholecystectomy, extraperitoneal hysterectomy and multiple parietal peritonectomies. A decision was made to perform a mesenterectomy using a Veress needle. A standard insuflator was utilized to a maximum pressure of 4 mmHg. CGR was achieved and the patient underwent HIPEC as per institution protocol. The post operative course was uneventful and the patient was discharged five days after surgery. She is currently free of disease (20 months after surgery).
Informed consent from the patient was obtained
None.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.gore.2022.101111.
Appendix A. Supplementary material
The following are the Supplementary data to this article:
References
- Casales Campos P.A., González Gil A., Gómez Ruiz Á.J., Balaguer Román A., Gil Gómez E., Alconchel Gago F., Martínez J., Nieto Díaz A., Barceló Valcárcel F., Gil M.J. Interval cytoreductive surgery and HIPEC in advanced ovarian cancer with small bowel disease: results and reflections. Clin. Translat. Oncol. 2022;24(8):1542–1548. doi: 10.1007/s12094-022-02795-x. [DOI] [PubMed] [Google Scholar]
- Heitz F., Harter P., Alesina P.F., Walz M.K., Lorenz D., Gräben H., Heikaus S., Fisseler-Eckhoff A., Schneider S., Ataseven B., Kurzeder C., Prager S., Beutel B., Traut A., du Bois A. Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer, following upfront radical debulking surgery. Gynecol. Oncol. 2016;141(2):264–270. doi: 10.1016/j.ygyno.2016.03.015. [DOI] [PubMed] [Google Scholar]
- Jurado, M., Chiva, L., 2021. Oncovascular surgery: is it time for a step forward in gynecologic oncology surgery? Int. J. Gynecol. Cancer. 2021;31(9):1315. [DOI] [PubMed]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.