Abstract

Around 60% of ovarian cancer is diagnosed in advanced stage – FIGO III or IV. Five year survival trends for women with this diagnosis have changed little, but it is stated that progression-free and overall survival is better in patients who have had a complete resection of the cancer. In order to achieve the best surgical result, one has to use „anatomical surgery“: En bloc resection for advanced ovarian cancer means using optimal anatomical approach to the tumor in a situation where the entire abdomen is the surgical compartment, which is the case for advanced ovarian cancer. The rational for using en bloc resection is the reported high rate of complete debulking, which means better survival outcome. Using anatomical landmarks and systematic approach to tumor could results in smaller blood loss in a situation where the oncological disease itself can raise the risk of perioperative bleeding. Less blood loss means smaller need for blood transfusion. Perioperative blood transfusion has been shown to be a predictor of early post-operative mortality. When blood loss is smaller and the surgery is completed with optimal movements, the operating time is shorter. Operation time and the amount of blood transfusion are related to possible intestinal anastomosis problems. Shorter operation can mean the possibility to offer more radial cytoreductive surgery for elderly patients. More than half of ovarian cancer cases are diagnosed in women aged 65 and over. Unfortunately, elderly people have shown to have less chance of receiving standard therapy. En bloc resection cases in literature have shown acceptable complication rates. Reducing operation time and blood loss means in general quicker recovery, shorter hospital stay. With optimal anatomical technique being established in a center, it is possible to teach and assess the surgeons in a more optimal way. It has been shown that structured management programs affect the rate of complete debulking and overall survival.

En bloc resection could potentially be a method which allows achievement of surgical and postoperative goals in the most optimal way