esgo ovarian cancer operative report · esgo ovarian cancer operative report. the guidelines and...
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ESGOOvarianCancerOPERATIVEREPORTESGO Guidelines, RecommendationsandAssuranceQualityCommittee
1
1. SurgeryData 1st SurgeonDr: 2nd Surgeon Dr: TypeofTumor:
Ca-125UI/mlatSurgery: SuspectedstageIV? Extraabdominallymphnodes
2.Surgical Approach and Findings
VolumenofAscites: FrozenSection: FrozenSectionDiagnosis:
Tumorinvolvement
Rightovary Uterus Rightgutter Smallbowelmesentery Liverparenchymal Celiac nodes
Leftovary Bladder/ureter Leftgutter Largebowelmesentery Lesseromentum Abdominalwall
Righttube Sigmoid-Rectum Smallbowel Paraaorticnodes Stomach Skin
Lefttube Recto-vaginalseptum Omentum Right diaphragm Pancreas Pericardiophrenicnodes
Douglas Pelvicwall Largebowel Leftdiaphragm Spleen Inguinalnodes
Vagina Pelvicnodes Appendix Liversurface Hepatichilumnodes Specifyother:
Hospital-Institution: City: Country:Identificationcode (for internal use only): Dateofbirth: DateofSurgery:
0Central1Rightupper2Epigastrium3Leftupper4Leftflank5Leftlower6Pelvis7Rightlower8Rightflank9Upperjejunum10Lowerjejunum11Upperileum12Lowerileum
PCI
0 Interaortocava/preaort.1 PortaHepatis2CeliacAxis3Suprarenal/Splenic4Left aortic5 Left common iliac6 Leftext iliac7 Left inguinal
9 Rightext iliac10Rightcommon iliac11Pre-Paracava12Right cardio phrenic13Left cardio phrenic
AimofSurgery:
IfYes,pleaseselect: SkinLungPleura
Abdominal wall Liver Parenchyma Spleen Parenchyma Other sites:
Approach: Type of procedure:
PRE POST
PERITONEAL CANCER INDEX
8 Right inguinal
+ R+ R0
+: Suspicious or Positive R+: Residual disease R0: No residual disease
RETROPERITONEAL DISEASE
Pf Status-ECOG
guidelines.esgo.org | [email protected] | Published October 2016 by European Society of Gynaecological Oncology | Copyrights: © European Society of Gynaecological Oncology | ESGO Operative Report_v2
ESGOOvarianCancerOPERATIVEREPORT.TheGuidelinesandAssuranceQualityCommittee
2
3. SurgicalProcedures.
Hysterectomy Pelvicnodes
Smallbowelresection
Livercapsuleresection
Unilateralsalpingooophorectomy
Paraaorticnodes
Largebowelresection
AtypicalLiverresection
Bilateralsalpingooophorectomy
InguinalnodesAppendicectomy
Parcialhepatectomy
Smallbowelmesentery
Pericardiophrenicnodes
Peritonectomy gutters
Cholecistectomy
Ureteralresection
Hepatichilumnodes
Diaphragmaticstripping Peritonectomy Morrison
Colorectalresection
Celiacaxis
Diaphragmaticresection
Resectionlesseromentum
Partialcystectomy Infracolicomentectomy Splenectomy
Partialgastrectomy
Pelvicperitonectomy Radicalomentectomy Partialpancreatectomy Other:
Nº anastomoses: Residualsmallbowel(cm): StomaFormation: Type:
Otherprocedures: IP-Port-a-cath IV-Port-a-cath Abdominalwallresection Meshplacement VATS HIPEC
Residualdisease(Intra-abdominal): No macroscopic 0.1-0.5cm 0.6-1cm >1cm
Anycommentthathasnotbeen specified:
Location/size of residual disease:
Durationoftheprocedure(minutes): EstimatedBloodLoss(cc): NºRBCunitstransfused:Severecomplicationsduringtheoperation:PatientwasbroughttoICUwith: NGtube FoleyCath EpiduralCath Endotrachealtube Chesttube Drain/s:(n)
Dateofcompletionofthisoperativereport: OperativeReportfilledbyDr:
Definitive Temporary
Residualdisease(Extra-abdominal): No macroscopic 0.1-0.5cm 0.6-1cm >1cm
Pelvic procedures Medium abdomen procedures Upper abdomen procedures
5ƛŦdzǎŜ {ŜNJƻǎŀƭ [ƛǾŜr tŀƴŎNJŜŀs {dzLJNJŀŘƛŀLJƘNJŀƎ. /ŜƭƛŀŎ !ȄƛǎReason of Residual : Other Hepatic hilum
guidelines.esgo.org | [email protected] | Published October 2016 by European Society of Gynaecological Oncology | Copyrights: © European Society of Gynaecological Oncology | ESGO Operative Report_v2