scholarly journals Surgical Techniques and Outcomes of Colorectal Anastomosis after Left Hemicolectomy with Low Anterior Rectal Resection for Advanced Ovarian Cancer

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4248
Author(s):  
Kyoko Nishikimi ◽  
Shinichi Tate ◽  
Ayumu Matsuoka ◽  
Satoyo Otsuka ◽  
Makio Shozu
Keyword(s):  
Ovarian Cancer ◽  
Colorectal Anastomosis ◽  
Rectal Stump ◽  
Advanced Ovarian Cancer ◽  
Colon Resection ◽  
Left Hemicolectomy ◽  
Tension Free ◽  
Stoma Creation ◽  
Anterior Rectal Resection ◽  
Intestinal Continuity

Extended colon resection is often performed in advanced ovarian cancer. Restoring intestinal continuity and avoiding stoma creation improve patients’ quality of life postoperatively. We tried to minimize the number of anastomoses, restore intestinal continuity, and avoid stoma creation for 295 patients with stage III/IV ovarian cancer who underwent low anterior rectal resection (LAR) with or without colon resection during cytoreductive surgery. When the remaining colon could not reach the rectal stump after left hemicolectomy with LAR, we used the following techniques for tension-free anastomosis: right colonic transposition, retro-ileal anastomosis through an ileal mesenteric defect, or an additional colic artery division. Rates of stoma creation and rectal anastomotic were 3% (9/295) and 6.6% (19/286), respectively. Among 21 patients in whom the remaining colon did not reach the rectal stump after left hemicolectomy with LAR, 20 underwent tension-free anastomosis, including eight, six, and six patients undergoing right colonic transposition, retro-ileal anastomosis through an ileal mesenteric defect, and an additional colic artery division, respectively. Colorectal anastomosis is feasible for patients with extended colonic resection. Low anastomotic leakage and stoma rates can be achieved with careful attention to colonic mobilization and tension-free anastomosis.

scholarly journals Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels

2021 ◽  
Author(s):  
Salomone Di Saverio ◽  
Kostantinos Stasinos ◽  
Weronyka Stupalkowska ◽  
Umberto Bracale ◽  
Pierpaolo Sileri ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Primary Anastomosis ◽  
Colorectal Anastomosis ◽  
Ascending Colon ◽  
Right Colon ◽  
Left Hemicolectomy ◽  
Tension Free ◽  
Descending Colon ◽  
Deloyers Procedure ◽  
The Right

Abstract Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.

Clinical outcome of resection of liver metastasis in patients with ovarian cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16545-e16545
Author(s):  
U. P. Neumann ◽  
C. Fotopoulou ◽  
P. Neuhaus ◽  
J. Sehouli
Keyword(s):  
Ovarian Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Advanced Ovarian Cancer ◽  
Residual Tumor ◽  
Small Bowel Resection ◽  
Colon Resection ◽  
Published Data ◽  
Term Survival

e16545 Background: Hepatic resection has become the standard treatment for resectable colorectal liver metastases. However, in patients with ovarian cancer resectable liver metastases are rare and the issue is discussed controversially due to the lack of relevant published data. The aim of this retrospective study was to evaluate the efficacy of hepatic resections in patients with ovarian cancer. Methods: Between 1991 and 2006 a total of 73 women with liver metastases underwent surgery for ovarian cancer. The median age of the patients was 59 years. 18 patients had primary and 55 suffered from recurrent disease. The median follow-up was 7 months (1–145 months). In 40 patients a liver resection was performed. In the remaining 33 patients the disease was unresectable. Additional procedures were: hysterectomy 15.1%, bilateral salpingo-oophorectomy 24.7%, omentectomy 32.9%, colon resection 50.7%, small bowel resection 32.9%, gastric resection 5.5%, and pancreatic resection 9.6%. Results: Residual tumor after surgery was by far the strongest predictor for outcome. Median survival in patients with no residual tumor was 65 months, < 0.5 cm 29 months, 1cm 6 months. This data clearly show that macroscopically complete surgical cytoreductive therapy improves long-term survival in patients with ovarian cancer and liver metastases. Conclusions: We still need to identify factors associated to complete debulking to minimize the number of ineffective operations. Therefore, liver resection should be always discussed if complete resection is achievable and should be part of the multimodal strategy in advanced ovarian cancer. No significant financial relationships to disclose.

scholarly journals Ghost ileostomy: prevention, diagnosis, and early treatment of colorectal anastomosis leakage in advanced ovarian cancer

2021 ◽  
pp. ijgc-2021-003060
Author(s):  
Victor Lago ◽  
Lourdes Sala Climent ◽  
Blanca Segarra-Vidal ◽  
Matteo Frasson ◽  
Blas Flor ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Treatment ◽  
Colorectal Anastomosis ◽  
Advanced Ovarian Cancer ◽  
Ghost Ileostomy ◽  
Anastomosis Leakage

8. Internationales Symposium Advanced Ovarian Cancer update: Das richtige Target definieren und gezieltere Kombinationstherapien

2011 ◽  
Vol 02 (03) ◽  
pp. 105-106
Author(s):  
Bettina Reich
Keyword(s):  
Ovarian Cancer ◽  
Advanced Ovarian Cancer

Seit 1996 ist das zweijährliche Weiterbildungsmeeting der spanischen Ovarialkarzinomgruppe eine Institution. Nunmehr wird es in Kooperation mit der ESMO durchgeführt, um insgesamt mehr Onkologen aus Europa zu erreichen. Denn die Behandlung des rezidivierten Ovarialkarzinoms stellt nach wie vor eine große Herausforderung dar. Zudem das Ovarialkarzinom meist erst im fortgeschrittenen Stadium entdeckt wird. Erst in den vergangenen Jahren konnten die Therapieoptionen in diesem Bereich etwas verbessert werden. Immer mehr zielgerichtete Kombinationen werden eingesetzt. Trotzdem muss eine noch genauere Zieldefinition am Anfang stehen, um letztlich wirklich Erfolge zu erzielen.

Chemoinducible Virotherapy for advanced ovarian cancer

2005 ◽  
Vol 127 (04) ◽  
Author(s):  
I Herrmann ◽  
M Porten ◽  
A Menzel ◽  
DT Curiel ◽  
D Niederacher ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Advanced Ovarian Cancer
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