Aspectos anatómicos y técnicos de la cirugia de citorredución de cáncer de ovario en abdomen superior / Anatomical and technical aspects of debulking surgery for ovarian cancer in the upper abdomen

RESUMEN El Cáncer de Ovario Epitelial es la novena causa de cáncer en la mujer y la neoplasia ginecológica más letal en países desarrollados. La mayoría de las pacientes son diagnosticadas en etapa avanzada de la enfermedad debido a la ausencia de síntomas específicos. La cirugía y la quimioterapia cumplen un rol fundamental en el tratamiento de esta enfermedad. En pacientes con enfermedad avanzada (estadios III - IV) al momento del diagnóstico, la extirpación de todo tumor macroscópico (citorreducción óptima) ha demostrado ser el factor pronóstico más importante, demostrando un beneficio tanto en tiempo libre de enfermedad como en sobrevida global. Nuestro objetivo es describir, desde una perspectiva multidisciplinaria, los aspectos técnicos más relevantes de la citorreducción del abdomen superior para aquellas pacientes con neoplasias de origen ginecológico.

ABSTRACT Epithelial Ovarian cancer is the ninth most frequent cancer in women and the most lethal gynecologic malignancy in developed countries. The majority of patients are diagnosed in advanced stage of the disease due to the lack of specific symptoms. Surgery and systemic treatment play a key role in the treatment of this disease. For those patients with advanced stage at the time of diagnosis (III - IV), removal of all macroscopic disease (optimal cytoreduction) has been shown as the most important prognostic factor, demonstrating improvement not only in progression free survival but also in overall survival. Our aim is to describe, in a multidisciplinary fashion, the most relevant aspect about oncological debulking procedures in the upper abdominal cavity for women with gynecological malignancies.

Acute Abdomen Secondary to Ruptured Epithelial Ovarian Cancer during Pregnancy: The Relevance of Teamwork / Abdome agudo secundário à ruptura do câncer do ovário epitelial durante a gravidez: a importância do trabalho em equipe

Abstract Acute abdomen secondary to epithelial ovarian cancer rupture during pregnancy is a rare event. Our aim is to present how the work of a coordinated multidisciplinary team in a case of ruptured epithelial ovarian cancer during pregnancy is feasible to obtain the best results possible. A 34-year-old woman during the 37th week of her first gestation presented with an acute abdomen. During laparotomy, a ruptured 16.5-cm left ovarian tumor was detected; the tumor was extirpated and sent to pathologic evaluation. In the meantime, a Kerr cesarean section was performed, and a healthy female neonate was born. The tumor was diagnosed as a cystadenocarcinoma; therefore, the family and the combined surgical team (obstetricians and a surgical oncologist) decided to complete a definitive radical ovarian cancer surgery: hysterectomy, right salpingooophorectomy, lymphadenectomy, omentectomy and appendectomy. The patient's postoperative evolution was uneventful, and she was sent to adjuvant chemotherapy.

Resumo O abdome agudo secundário à ruptura do câncer do ovário epitelial durante a gravidez é um evento raro. Nosso objetivo é apresentar como o trabalho de uma equipe multidisciplinar coordenada em um caso de ruptura do câncer de ovário epitelial durante a gravidez é viável para obter os melhores resultados possíveis. Umamulher de 34 anos de idade, durante a 37a semana de sua primeira gestação, apresentou um abdome agudo. Durante a laparotomia, foi detectado um tumor ovariano esquerdo com ruptura de 16,5 cm; O tumor foi extirpado e enviado para avaliação patológica. Enquanto isso, uma cesariana de Kerr foi feita, e uma recém-nascida saudável nasceu. O tumor foi diagnosticado como um cistoadenocarcinoma; então, a família e a equipe cirúrgica combinada (obstetras e oncologista cirúrgico) decidiram concluir uma cirurgia radical definitiva do câncer de ovário: histerectomia, salpingo-ooforectomia direita, linfadenectomia, omentectomia e apendicectomia. A evolução pós-operatória da paciente foi sem intercorrências, e ela foi enviada para quimioterapia adjuvante.

El cáncer de ovario, el asalto del homicida invisible / Ovarian cancer, the assault by an invisible murderer

El cáncer de ovario se origina de 3 tipos de células: células epiteliales, células germinales y células del estroma. Aproximadamente el 90% de los casos de cáncer de ovario son del tipo epitelial, que es la forma más frecuente de los 3 tipos histológicos y desafortunadamente una de las principales causas de muerte por cáncer del aparato reproductor femenino, al ser una enfermedad con sintomatología insidiosa e inespecífica, que lamentablemente tiene una mortalidad extremadamente alta. La incidencia de este tipo de estirpe aumenta con la edad, y a diferencia del de las células germinales y del estroma, son raros antes de los 40 años. Es importante saber que tanto en México como a nivel global, la variedad en incidencia del subtipo histológico del cáncer epitelial de ovario se da en las siguientes proporciones: seroso (60-80%), mucinoso (10-25%), endometrioide (8-20%), de células claras (5%), tumor de Brenner (< 1%) e indiferenciado. Esto nos muestra que el cáncer de ovario epitelial seroso es el más frecuente en el mundo, y por lo tanto, el que más asecha a las mujeres.

Ovarian cancer develops from three kinds of cells: epithelial cells, germ cells, and stromal cells. About 90% of ovarian cancer is of the epithelial kind, thus being the most frequent of the three histological types and, unfortunately, one of the main causes of death by female reproductive system cancer; due to the insidious and unspecific symptomatology of this disease, which, regrettably, has an extremely high mortality. The incidence of this kind of lineage increases with age and, unlike germ and stromal cancers, it is rare before the fifth decade of life. It is important to know that in Mexico as well as in the rest of the world, that the incidence of the different varieties of the histological subtype of ovarian epithelial cancer is as follows: serous (60-80%), mucinous (10-25%), endometrioid (8-20%), clear cells (5%), Brenner tumor (<1%) and not differentiated. Epithelial-serous ovarian cancer is the most frequent in the world; therefore, the one we fear hunts most of our women.