Evaluation of supragastric lesser sac using a laparoscope during cytoreductive surgery in epithelial ovarian carcinoma: A site for occult metastasis

• Published in: Asian Journal of Oncology Vol. 2; no. S 01
• Main Authors: Mukhopadhyay, Asima, Basu, Kaustav, Helm, William
• Format: Conference Proceeding
• Language: English
• Published: A-12, Second Floor, Sector -2, NOIDA -201301, India Thieme Medical and Scientific Publishers Private Ltd 01.07.2016
• Subjects: Ovary: Oral Abstract
• ISSN: 2454-6798; 2455-4618
• DOI: 10.1055/s-0039-1685290

Background: The supragastric lesser sac (SGLS) is a site of metastasis from epithelial ovarian cancer (EOC). Since this region is difficult to access and represents a confluence of critical structures, it may be a barrier to complete cytoreductive surgery (CRS). Methods: The SGLS was explored in consecutive patients undergoing CRS with EOC. After a xipho-pubic laparotomy incision, the SGLS was examined; visualisation and treatment was aided by using a laparoscope. Resectable disease was cleared using the following methods alone or in combination: direct tumor excision, argon beam coagulation, plasma jet or electrocautery. Results: 30 patients were evaluated between November 2013 and August 2014 in NGOC, Gateshead. SGLSM was present in 21/30 (70%) of EOCs, 19/25 (76%) high grade serous disease, 21/26 (81%) stage ≥3 disease, 18/20 (90%) with PCI score ≥15, 12/15 (80%) with ascites ≥500 ml, 13/18 (72%) at primary surgery and 8/10 (80%) at interval surgery. Sites included: lesser omentum (11), caudate lobe (10), groove of ligamentum venosum (6), floor (20), upper recess (7), subpyloric space (6), FOW (13), coeliac axis (5), porta hepatis (6), anterior surface of pancreas (2) retro-pancreatic (2). Size of metastases: <2.5mm = 3, <1 cm = 8, ≥1 cm = 7. Pre-operative CT scan identified 4/22 (18%) cases. In 18/21 patients SGLSM was completely resected or ablated; there were no complications. End Result: Optimal 27/30 (90%) including no visible disease = 18, <2.5 mm = 5; 17/21 (81%) cases would have been ≥2.5 mm residual disease if SGLS was not evaluated/treated. In a further cohort of 30 patients evaluated at Tata Medical Center, Kolkata, SGLSM was present in 18 (60%) of patients. CC1 resection was obtained in >90% cases. Conclusion: EOC frequently metastasizes to the SGLS and is often resectable. Lack of meticulous examination may result in incomplete resection; evaluation should be performed at least in stage ≥3 disease when the surgical intent is total clearance of disease.