EC Gynaecology

Advanced ovarian cancer frequently involves upper abdominal structures, including the spleen. To achieve complete surgical cytoreduction, the extensive upper abdominal procedures may be included in the gynecologic oncologist knowledge and surgical practice of the gynecological oncologist. This article presents the relevant anatomy and surgical methods required for a proactive approach to cytoreduction in the upper left quadrant. Moreover, as the spleen is the largest lymphoid organ and deleterious events resulting from splenectomy are a major concern in these patients, thus, the influence of splenectomy on chemotherapy treatment and oncological prognosis are also discussed.

Keywords: Splenectomy in Advanced Ovarian Cancer: Technique; Perioperative Considerations; Impact on Chemotherapy; Tertiary Referral Institution

1. Torre LA., et al. “Ovarian cancer statistics, 2018”. Clinical Cancer Investigation Journal4 (2018): 284-296.
2. Colombo N., et al. “Ovarian cancer”. Critical Reviews in Oncology/Hematology2 (2006): 159-179.
3. Melamed A., et al. “Associations between residual disease and survival in epithelial ovarian cancer by histologic type”. Gynecologic Oncology2 (2017): 250-256.
4. González Martín A., et al. “Exploratory outcome analyses according to stage and/or residual disease in the ICON7 trial of carboplatin and paclitaxel with or without bevacizumab for newly diagnosed ovarian cancer”. Gynecologic Oncology1 (2019): 53-60.
5. Jones NL., et al. “National trends in extended procedures for ovarian cancer debulking surgery”. International Journal of Gynecological Cancer1 (2018): 19-25.
6. Koh YS., et al. “Splenectomy for solitary splenic metastasis of ovarian cancer”. BMC Cancer 4 (2004): 96-96.
7. Sun H., et al. “Splenectomy during cytoreductive surgery in epithelial ovarian cancer”. Cancer management and Research 10 (2018): 3473-3482.
8. Fotopoulou C., et al. “Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities”. Archives of Gynecology and Obstetrics3 (2016): 607-614.
9. Hanprasertpong J and Fujiwara K. “Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review”. European Journal of Cancer Care3 (2011): 287-293.
10. Magtibay PM., et al. “Splenectomy as part of cytoreductive surgery in ovarian cancer”. Gynecologic Oncology2 (2006): 369-374.
11. Zapardiel I., et al. “Splenectomy as part of primary cytoreductive surgery for advanced ovarian cancer: a retrospective cohort study”. International Journal of Gynecological Cancer6 (2012): 968-973.
12. De Porto AP., et al. “Assessment of splenic function”. European Journal of Clinical Microbiology and Infectious Diseases12 (2010): 1465-1473.
13. Weledji EP. “Benefits and risks of splenectomy”. International Journal of Surgery2 (2014): 113-119.
14. Filippova OT., et al. “Hematologic changes after splenectomy for ovarian cancer debulking surgery, and association with infection and venous thromboembolism”. International Journal of Gynecological Cancer8 (2020): 1183-1188.
15. Diener MK., et al. “Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial”. Lancet9776 (2011): 1514-1522.
16. Lipson RL., et al. “The postsplenectomy blood picture”. American Journal of Clinical Pathology 32 (1959): 526-532.
17. Ramirez PT and Dos Reis R. “Splenectomy in patients with advanced or recurrent ovarian cancer: open and laparoscopic surgical techniques and clinical outcomes”. Gynecologic Oncology2 (2007): 29-32.
18. Howdieshell TR., et al. “Surgical infection society guidelines for vaccination after traumatic injury”. Surgical Infections3 (2006): 275-303.
19. Qu Y., et al. “Management of postoperative complications following splenectomy”. International Surgery1 (2013): 55-60.
20. Lee EJ., et al. “Splenectomy and distal pancreatectomy in advanced ovarian cancer”. Gland Surgery3 (2021): 1218-1229.
21. Bassi C., et al. “Postoperative pancreatic fistula: an international study group (ISGPF) definition”. Surgery1 (2005): 8-13.
22. Fotopoulou C., et al. “European Society of Gynaecological Oncology guidelines for the peri-operative management of advanced ovarian cancer patients undergoing debulking surgery”. International Journal of Gynecological Cancer9 (2021): 1199-1206.
23. Alexander M., et al. “Timely initiation of chemotherapy: a systematic literature review of six priority cancers - results and recommendations for clinical practice”. Journal of Internal Medicine1 (2017): 16-34.
24. Mahner S., et al. “Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: analysis of prospective randomised phase III trials”. European Journal of Cancer1 (2013): 142-149.
25. Hofstetter G., et al. “The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma - analysis of patient data in the prospective OVCAD study”. Gynecologic Oncology1 (2013): 15-20.
26. Wright J., et al. “Variability in chemotherapy delivery for elderly women with advanced stage ovarian cancer and its impact on survival”. British Journal of Cancer7 (2008): 1197-1203.
27. Tewari KS., et al. “Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study”. Annals of Oncology1 (2016): 114-121.
28. Wright JD., et al. “Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer”. Obstetrics and Gynecology4 (2012): 871-881.
29. Timmermans M., et al. “Interval between debulking surgery and adjuvant chemotherapy is associated with overall survival in patients with advanced ovarian cancer”. Gynecologic Oncology3 (2018): 446-450.
30. Flynn PM., et al. “Does the interval from primary surgery to chemotherapy influence progression-free survival in ovarian cancer?” Gynecologic Oncology3 (2002): 354-357.
31. Gadducci A., et al. “Relationship between time interval from primary surgery to the start of taxane- plus platinum-based chemotherapy and clinical outcome of patients with advanced epithelial ovarian cancer: results of a multicenter retrospective Italian study”. Journal of Clinical Oncology4 (2005): 751-758.
32. Paulsen T., et al. “Influence of interval between primary surgery and chemotherapy on short-term survival of patients with advanced ovarian, tubal or peritoneal cancer”. Gynecologic Oncology3 (2006): 447-452.
33. Aletti GD., et al. “Is time to chemotherapy a determinant of prognosis in advanced-stage ovarian cancer?” Gynecologic Oncology1 (2007): 212-216.
34. Anuradha S., et al. “Variations in adjuvant chemotherapy and survival in women with epithelial ovarian cancer - a population-based study”. Acta Oncologica2 (2016): 226-233.
35. Rosa DD., et al. “The interval from surgery to chemotherapy in the treatment of advanced epithelial ovarian carcinoma”. European Journal of Surgical Oncology5 (2006): 588-591.
36. Lydiksen L., et al. “Is it possible to define an optimal time for chemotherapy after surgery for ovarian cancer?” Gynecologic Oncology3 (2014): 454-459.
37. Sorbe B. “Prognostic importance of the time interval from surgery to chemotherapy in treatment of ovarian carcinoma”. International Journal of Gynecological Cancer5 (2004): 788-793.
38. Starbuck KD., et al. “Prognostic impact of adjuvant chemotherapy treatment intensity for ovarian cancer”. PLoS One11 (2018): e0206913.
39. Seebacher V., et al. “The impact of the duration of adjuvant chemotherapy on survival in patients with epithelial ovarian cancer - a retrospective study”. PLoS One1 (2017): e0169272.
40. Buzelé R., et al. “Medical complications following splenectomy”. Journal of Visceral Surgery4 (2016): 277-286.
41. Cadili A and De Gara C. “Complications of splenectomy”. The American Journal of Medicine5 (2008): 371-375.