Objective.:Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures f...Objective.:Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.:Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.:Of 112 patients,66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%),formal lymphadenectomy (31%),or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%),facilitation of an en bloc resection of perisplenic disease (41%),and intraoperative trauma (13%). Histologically,65%had hilar involvement; 52%,capsular involvement; and 16%,parenchymal metastases. Short-term complications included wound infections (7),pneumonias (5),thromboembolic events (9),and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient,with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess),and with no identifiable infectious source in 2. Two patients required reoperation for bleeding:1 for diffuse intraabdominal bleeding,including the splenic bed,and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%:3 from sepsis (1 anastomotic leak,2 pneumonias),2 from pulmonary embolism,and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years,with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years,with an estimated 2-year survival of 42%. Conclusions.:In patients with clinically significant upper abdominal disease,splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.展开更多
Objective: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome. Study design: Data were abstracted from records of patients with a history of bilateral salpingo-oophorect...Objective: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome. Study design: Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual ovarian tissue. A follow-up questionnaire was also mailed. Results: Records review identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85% ) underwent oophorectomy by laparotomy, 13 (7% ) by laparoscopy, and 14 (8% ) by transvaginal approach, mostly for endometriosis (56.8% ). Of 186 patients, 105 (57% ) presented with pelvic masses and 89 (48% ) with pelvic pain. Remnant ovarian tissue was associated with a corpus luteum in 78 (42% ) and endometriosis in 54 (29% ). The intraoperative complication rate was 9.6% . Of 142 patients, 12 (9% ) required subsequent re-exploration (1 ovarian remnant identified). Conclusion: This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic sidewall stripping and apical vaginal excision. However, subsequent recurrence is minimal ( < 1% ). More than 90% of patients reported resolution or marked improvement of symptoms.展开更多
文摘Objective.:Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.:Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.:Of 112 patients,66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%),formal lymphadenectomy (31%),or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%),facilitation of an en bloc resection of perisplenic disease (41%),and intraoperative trauma (13%). Histologically,65%had hilar involvement; 52%,capsular involvement; and 16%,parenchymal metastases. Short-term complications included wound infections (7),pneumonias (5),thromboembolic events (9),and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient,with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess),and with no identifiable infectious source in 2. Two patients required reoperation for bleeding:1 for diffuse intraabdominal bleeding,including the splenic bed,and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%:3 from sepsis (1 anastomotic leak,2 pneumonias),2 from pulmonary embolism,and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years,with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years,with an estimated 2-year survival of 42%. Conclusions.:In patients with clinically significant upper abdominal disease,splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.
文摘Objective: This study was undertaken to examine surgical management of patients with ovarian remnant syndrome. Study design: Data were abstracted from records of patients with a history of bilateral salpingo-oophorectomy who were treated surgically at Mayo Clinic between 1985 and 2003 for pathologically confirmed residual ovarian tissue. A follow-up questionnaire was also mailed. Results: Records review identified 186 patients (mean age, 37.6 years; mean follow-up, 1.2 years). Of 180 patients with available data, 153 (85% ) underwent oophorectomy by laparotomy, 13 (7% ) by laparoscopy, and 14 (8% ) by transvaginal approach, mostly for endometriosis (56.8% ). Of 186 patients, 105 (57% ) presented with pelvic masses and 89 (48% ) with pelvic pain. Remnant ovarian tissue was associated with a corpus luteum in 78 (42% ) and endometriosis in 54 (29% ). The intraoperative complication rate was 9.6% . Of 142 patients, 12 (9% ) required subsequent re-exploration (1 ovarian remnant identified). Conclusion: This heavily pretreated population has modest risk of bowel, bladder, or ureteral trauma with definitive pelvic sidewall stripping and apical vaginal excision. However, subsequent recurrence is minimal ( < 1% ). More than 90% of patients reported resolution or marked improvement of symptoms.
