Explain：Ovarian cancer post chemotherapy

Content: second look operation

Clinical Information:

The female patient had irregular menstruation and lower abdominal pain for years, and a progressive abdomen fullness for months. A complex tumor with irregular echogenetic density mass over pelvis with marked visible ascites was disclosed by ultrasonography. Under the impression of an ovarian malignancy, maximal debulking operation for ovarian malignancy had been performed. Patient had received cisplatin base chemotherapy for 4-6 courses. Now second look operation for reevaluation the cancer status was plan. . Chest x ray imaging was normal. Oncologic survey including pelvic and abdominal tomography, color doppler sonography, and tumor makers were performed. After the intestinal tract prepared and the patient's permission for a cytoreductive surgery obtained, Second look laparotomy was arranged.

The biochemical data are: CEA:_______, CA-125:________, AFP:_______, beta-hCG:_______, CA19.9:_______, LDH:_______,

Operative Procedures:

Type of operation: second look operation + {{hysterectomy, BSO, tumor debulking, BPLD, multiple peritoneal excision, omentectomy, appendectomy, enterolysis, cytology}}.

The patient is placed in the supine position. The patients be operated on through an extended midline incision. The incision should extend from the symphysis pubis well above the umbilicus and, in many cases, up to the xiphoid. The initial exploration should start under the diaphragm and this area should be either visualized directly and palpation. If studding is found either under the left or the right diaphragm, the small masses should be biopsied . Washings should be obtained from five separate areas in the abdominal cavity under each diaphragm, in each lateral gutter, and in the pelvis. These should be sent to the laboratory for cytopathologic studies. The exploration of the retroperitoneal space is begun by elevating the peritoneum between the cecum

and the terminal ileum The peritoneum is incised parallel to the right common iliac artery and then advanced up the aorta until the third portion of the duodenum is encountered. At the third portion of the duodenum the ligament of Treitz is noted and mobilized along with the duodenum to allow adequate exposure to the renal vessels. Lymph node biopsies are begun at the level of the renal artery and vein, the origin of the right and left ovarian vessels. Adequate lymph sampling is performed along the aorta. The peritoneum overlying the aorta is closed with a chromic catgut sutures. Meticulous reperitonization should be performed over the aorta to reduce adhesion formation between the aorta and small bowel. At this point, the oncologic procedure of tumor bulking for ovarian carcinoma can be initiated. All adhesion tissues or suspected lesions should be biopsied. The visible or palpable malignant tissues should be removed completely as possible. The remained omentum, appendix, or questionable adnexa may be removed on the same time.

Operative Findings:

Complication:

Pathology:

Dr:________________. Date: _______________.