THE PELVIC RETROPERITONEAL APPROACH IN THE TREATMENT OF ADVANCED OVARIAN-CARCINOMA

Objective: To evaluate the feasibility, complications, and clinical ro le of pelvic cytoreduction using the retroperitoneal approach in the t reatment of advanced ovarian cancer. Methods: We studied 66 women with previously untreated advanced ovarian cancer who underwent pelvic ret roperitoneal surgery. The possibility of achieving extrapelvic cytored uction (residual disease less than 2 cm), involvement of the Douglas c ul-de-sac or vesicouterine fold, or the presence of a frozen pelvis we re indications for the retroperitoneal approach. Operative time, blood loss and transfusions, perioperative complications, and postoperative stay were analyzed prospectively. The performance status of each pati ent was assessed preoperatively and postoperatively. Results: The pelv ic retroperitoneal approach was used in 66 of 147 (45%) consecutive pa tients who underwent primary surgery with intent of cytoreduction. Thi s approach was necessary in 60 of 94 (64%) patients with residual tumo r less than 0.5 cm and contributed to achieving such a minimal residua l disease in 36 of 38 (95%) stage IIB-IIIB and 58 of 109 (53%) IIIC-IV patients. Severe morbidity, but with no longterm sequelae, occurred i n six (9%) patients. Before surgery, only ten (15%) of these patients had a performance status grade 0-1, 21 (32%) had grade 2, and 35 (53%) grade 3-4. After surgery, these figures were 52 (79%), 14 (21%), and 0, respectively. The 5-year survival rate was 37%, with a median survi val and follow-up time of 27 months (range 4-98) and 43 months, respec tively. Conclusion: If the proper technique is used, complete pelvic c ytoreduction is always feasible and morbidity is acceptable. In our se ries, it was necessary to approach the pelvis retroperitoneally in 64% of optimally cytoreduced patients, which suggests that this technique has an important clinical role in the treatment of patients with adva nced ovarian cancer.