Liver Resection

When parenchymal liver disease is present, a partial liver resection can be attempted. Hepatic resection is considered safe, with a mortality rate of less than 5%, but it is not yet regarded as standard of care for the treatment of ovarian cancer. Bristow and associates22 identified a 50.1-month median survival in patients who were optimally cytoreduced of extrahepatic and parenchymal liver disease compared with 27.0 months in patients with optimal extrahepatic disease but suboptimal residual hepatic tumor. Patients with suboptimal extrahepatic and suboptimal hepatic residual disease had a median survival of only 7.6 months. Radiofrequency ablation has been explored as an alternative to conventional surgery for metastatic hepatic tumors. It allows the ablation of multiple lesions and is best suited for small lesions that are peripheral to major vascular structures23 (Fig. 7-13).

Figure 7-13. Abdominal CT scan at the time of the percutaneous radiofrequency ablation (RFA) of the liver metastasis. Note the tines that have been deployed from the RFA electrode into the tumor mass. The thermal necrosis of the tumor is seen acutely with gas and debris in the tumor bed (arrow). (From Bojalian MO, Machado GR, Swensen R, et al: Radiofrequency ablation of liver metastasis from ovarian adenocarcinoma: case report and literature review. Gynecol Oncol 93:557-560, 2004, Figure 2.)

Figure 7-13. Abdominal CT scan at the time of the percutaneous radiofrequency ablation (RFA) of the liver metastasis. Note the tines that have been deployed from the RFA electrode into the tumor mass. The thermal necrosis of the tumor is seen acutely with gas and debris in the tumor bed (arrow). (From Bojalian MO, Machado GR, Swensen R, et al: Radiofrequency ablation of liver metastasis from ovarian adenocarcinoma: case report and literature review. Gynecol Oncol 93:557-560, 2004, Figure 2.)

Figure 7-14. A, To ensure adequate exposure, a lower abdominal midline Incision should be extended to the xiphoid process. B, Extensive tumor involvement of the omentum with extension to the greater curvature of the stomach and to the hilum and capsule of the spleen. (From Morris M, Gershenson DM, Burke TW, et al: Splenectomy in gynecologic oncology: indications, complications, and technique. Gynecol Oncol 43:118-122, 1991, Figure 2.)

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