[Retroperitoneal approach and pelvic peritoneoectomy in the surgical management of advanced ovarian cancer].

OBJECTIVE: To share our experience in surgical management of advanced ovarian cancer applying a retroperitoneal approach and performing pelvic peritoneoectomy for the achievement of an optimal debulking in this disease. MATERIAL: Thirty eight patients age ranging from 36 to 77 years (average 55,7 years) staged: I - 2 (5,3%), II - 4 (10,5%), //III/ - 28 (73,7%) and IV - 4 (10,5%) had been operated on. Thirty patients presented without previous therapy, 3 - after total abdominal hysterectomy with adnexes, 1 - after supravaginal hysterectomy with adnexes, 1 - after unilateral adnexectomy and 3 - after neoadjuvant chemotherapy. METHODS: All 38 patients had been submitted to retroperitoneal approach during the laparotomy and it had been performed surgical procedures including various degrees of radicalness towards the pelvic structures (uterus, parameters vagina) with or without pelvic peritoneoectomy. The latter had been performed in 28 patients (73,7%). Selective lymph node dissection is carried out in 21 cases (55,3%), total omentectomy - in 36 cases (94,7%) and appendectomy - in 23 (60,5%). RESULTS: Maximal (no evidence of disease) and optimal (less than 2 cm lesion) cytoreduction is achieved in 23 (60,5%) and 8 (21,1%) patients, respectively - totally in 81,6% of all patients. The most common site of suboptimal (> 2 cm) residual masses is the anterior rectal wall and cavum Douglasi - 85,7%, Lymph node metastases is detected in 33%, metastases in omentum - in 75%, parametrial invasion - in 25%, vaginal metastases - in 8,3%, metastases in appendix and Fallopian tubes - in 47,8% and 8,8%, respectively and invasion of tumor's capsula - in 34, 2%. CONCLUSION: Retroperitoneal approach and pelvic peritoneoectomy are feasible and safe and lead to high percentage of optimal debulking, which is the main prognostic factor in advanced ovarian cancer patients.