intra operative management of ovarian neoplasia
TRANSCRIPT
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Intra-operative Management
ROSSHINI JAGATHESWARAN
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Objectives
• Diagnosis
• Staging
• Treatment
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Primary Treatment
• Exploratory laparotomy
• Total abdominal hysterectomy bilateral
salphingoophorectomy
• Omentectomy
• Random peritoneal biopsy
Peritoneal fluidPelvic and para-aortic
lymphadenectomy
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Advanced stage
• Cytoreduction/Debulking
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Surgery
• Vertical midline incision
• Ascites/peritoneal washings are sampled
• TAHBSO + infracolic omentectomy
• Further debulking – resection of bowel,
peritoneal stripping, spleenectomy
• Lymph node resection
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FIGO Staging
STAGE I
Ia – limited to 1 ovary,
no external tumor,
capsule intact, no
ascites
Ib– limited to both
ovary, no external
tumor, capsule intact,
no ascites
Ic– either Ia or Ib, but
tumor on surface or
with capsule ruptured
or with ascites positive
for tumor calls
Growth limited to ovaries
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IIa – extension and or
metastases to uterus
or tubes
IIb – extension to other
pelvic organ
IIc – as IIa or IIb, but
tumor on surface of
ovary or capsule
ruptured or with ascites
positive for tumor cells
Growth limited to pelvis
STAGE II
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IIIa – Tumor grossly
limited to pelvis with
negative nodes, but
histologically
confirmed
microscopic
peritoneal implant
IIIb – Abdominal
implant < 2cm in
diameter
IIIc – Abdominal
implants > 2cm
diameter or positive
retroperitoneal or
inguinal lymph
nodes
Growth limited to abdominal peritoneal or positive retroperitoneal
or inguinal lymph nodes
STAGE III
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STAGE IV
Growth involving one or both ovaries with distant
metastases
Must have positive cytology in pleural effusion, liver
parenchyma
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I want to have more babies, Dr!
• Unilateral salpingo-oophorectomy
• Omentectomy
• Peritoneal biopsies
• Pelvic/paraortic node dissection
• Endometrial sampling
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Surgery, NO!!!!
• Primary chemotherapy
• Interval surgery after 3-6 cycles
• Similarly Interval debulking
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Gynae & Onco
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Our Duty as Physicians
To cure sometimes.
To treat often.
To Comfort always.
Hippocrates (c.460 - 400 BC).