Hie

Division of Cul-de-sac cardinal ligs. tumor

Cul-de-sac tumor

Figure 7-8. Radical oophorectomy. The rectovaginal space has been developed to a level 2 to 3 cm below the caudal-most extent of the cul-de-sac tumor mass, and the distal rectosigmoid colon is divided using an automated stapling device. (From Bristow RE, del Carmen MG, Kaufman HS, et al: Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197:565-574, 2003, Figure 4.)

Recto-sigmoid colon divided with stapler

Cul-de-sac tumor

Recto-sigmoid colon divided with stapler

Figure 7-8. Radical oophorectomy. The rectovaginal space has been developed to a level 2 to 3 cm below the caudal-most extent of the cul-de-sac tumor mass, and the distal rectosigmoid colon is divided using an automated stapling device. (From Bristow RE, del Carmen MG, Kaufman HS, et al: Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197:565-574, 2003, Figure 4.)

End-to-end anastomosis to rectal stump

Figure 7-9. Radical oophorectomy.

Intestinal continuity is reestablished using a circular end-to-end anastomosis (CEEA) automated stapling device. Sym., symphysis pubis (From Bristow RE, del Carmen MG, Kaufman HS, et al: Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197:565-574, 2003, Figure 7.)

End-to-end anastomosis to rectal stump

Figure 7-9. Radical oophorectomy.

Intestinal continuity is reestablished using a circular end-to-end anastomosis (CEEA) automated stapling device. Sym., symphysis pubis (From Bristow RE, del Carmen MG, Kaufman HS, et al: Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197:565-574, 2003, Figure 7.)

Figure 7-10. Radical oophorectomy. The pelvis is macroscopically tumor-free after en bloc resection. (From Bristow RE, del Carmen MG, Kaufman HS, et al: Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197:565-574, 2003, Figure 6.)

Figure 7-10. Radical oophorectomy. The pelvis is macroscopically tumor-free after en bloc resection. (From Bristow RE, del Carmen MG, Kaufman HS, et al: Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197:565-574, 2003, Figure 6.)

of the bowel is restored using a circular end-to-end anastomotic stapler (Figs. 7-9 and 7-10).

In their series of 31 consecutive patients, Bristow and associates17 encountered no postoperative deaths, but 4 of 31 (13%) of patients developed life-threatening postoperative complications with one patient undergoing a re-exploration for an anasto-motic breakdown. This procedure should therefore not be undertaken in women with unresectable upper abdominal disease because of the procedure's high morbidity and low potential for cure.

Intestinal involvement in epithelial ovarian cancer frequently affects the rectosig-moid colon, and rectosigmoid resection represents the majority of gastrointestinal surgeries performed in patients with epithelial ovarian cancer. This surgery is often necessary to obtain optimal cytoreduction.18 In one of the largest series, the morbidity associated with en bloc resection of ovarian carcinoma with low rectosigmoid resection and anastomosis was 6.7%. In a number of cases, superficial implants can simply be shaved off, but bulkier implants may require resection and anastomosis, particularly in the presence of obstruction.19 As stated earlier, bowel resection should be carried out only when optimal cytoreduction is possible or when obstruction is present.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment