Extra-peritoneal hysteroannessiectomy with eventual concomitant en bloc rectal resection and cytoreductive surgery in epithelial ovarian cancer (and other peritoneal surface malignancies): technical details

Surgery allows the correct evaluation of the peritoneal dissemination of the epithelial ovarian cancer (EOC) and the removal of as much tumor as possible to maximize adjuvant chemotherapy. Neoadjuvant chemotherapy (NACT) and interval debulking surgery have been proposed as a reasonable alternative to primary complete cytoreductive surgery (CRS) in patients not fit for an initial extensive debulking surgery. Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has been offered as a promising therapeutic procedure to increase survival by treating the microscopic component of the neoplastic disease. Matherial and Method. 419 eligible patients with stage III-IV EOC were subjected to CRS, previous NACT in 343 patients, 20 of which with CRS combined with extraperitoneal hysterectomy (EH) + HIPEC. Purposes of our four years retrospective observational study are the revision of the surgical approaches to the EOC, a detailed report of the pelvic peritonectomy in association to hysteroannessiectomy (+/- consensual rectal resection) and the prospective review of the results. Conclusions. This study shows that EH + HIPEC is feasible. The detailed description of the technique here depicted could help to standardize this type of peritonectomy.