Ovarian cancer (OC), the most lethal gynecological malignancy, usually presents in advanced stages. Characterized by peritoneal and lymphatic dissemination, OC necessitates a complex surgical approach usually involving the upper abdomen with the aim of achieving optimal cytoreduction without visible macroscopic disease (R0). Failures in optimal cytoreduction, essential for prognosis, often stem from overlooking anatomical neglected sites that harbor residual tumor. Concealed OC metastases may be found in anatomical locations such as the omental bursa; Morison’s pouch; the base of the round ligament and hepatic bridge; the splenic hilum; and suprarenal, retrocrural, cardiophrenic and inguinal lymph nodes. Hence, mastery of anatomy is crucial, given the necessity for maneuvers like liver mobilization, diaphragmatic peritonectomy and splenectomy, as well as dissection of suprarenal, celiac, and cardiophrenic lymph nodes in most cases. This article provides a meticulous anatomical description of neglected anatomical areas during OC surgery and describes surgical steps essential for the dissection of these “neglected” areas. This knowledge should equip clinicians with the tools needed for safe and complete cytoreduction in OC patients.
卵巢癌作为致死率最高的妇科恶性肿瘤，通常确诊时已进展至晚期。该病以腹膜和淋巴扩散为特征，需采用复杂的手术方法，通常涉及上腹部区域，旨在实现无肉眼可见病灶的满意肿瘤细胞减灭术（R0）。影响预后的满意减瘤术失败常源于对隐匿残留肿瘤解剖部位的忽视。卵巢癌隐匿转移灶可能存在于以下解剖位置：网膜囊、莫里森陷凹、圆韧带基底与肝桥、脾门区域，以及肾上腺区、膈肌脚后、心膈角与腹股沟淋巴结。鉴于多数病例需实施肝脏游离、膈肌腹膜切除术、脾切除术，以及肾上腺区、腹腔干和心膈角淋巴结清扫等操作，掌握相关解剖知识至关重要。本文系统阐述了卵巢癌手术中易被忽视的解剖区域，并详细介绍了这些"被忽视区域"清扫的关键手术步骤。该知识体系将为临床医生提供对卵巢癌患者实施安全、完整肿瘤细胞减灭术所需的技术支持。
Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery
肿瘤(癌症)患者之家