A 54-yrs-old woman undergoes a laparotomy because of a pelvic mass. At exploratory laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental metastasis. Frozen section diagnosis confirms metastatic serous cystadenocarcinoma. The most appropriate intraoperative course of action is:-
The patient in the question has advanced stage ovarian malignancy (stage IIIC) MANAGEMENT OF OVARIAN EPITHELIAL CANCER EARLY Low risk Stage 1A, 1B, low grade Surgical staging High risk Stage 1C, high grade Surgical staging + adjuvant chemotherapy ADVANCED Stage II, III, IV Maximal cytoreduction + adjuvant chemotherapy STEPS OF COMPREHENSIVE SURGICAL STAGING Veical midline incision Ascitic fluid for cytology If no ascites : take peritoneal washings Biopsy of suspicious lesions and diaphragm Omentectomy Retroperitoneal lymph node evaluation IMPOANT POINTS Maximal cytoreduction: means removal of entire pelvic tumor + resection of metastasis Optimal debulking: less than 1 cm of residual lesion Feility sparing surgery (unilateral salpingo-oophorectomy): Stage 1A with low grade, Bordeline tumors Neo adjuvant chemotherapy: Stage III and IV with massive ascites, massive pleural effusion, unresectable tumor. iT increases chances of optimal debulking
Excision of the omental metastasis and ovarian cystectomy
Omentectomy and ovarian cystectomy
Excision of the omental metastasis and unilateral oophorectomy
Omentectomy, total abdominal hysterectomy, and bilateral salpingo oophorectomy
Ovarian Tumors and Vulvar cancer