Porta hepatis peritonectomy and hepato–celiac lymphadenectomy in patients with stage IIIC–IV ovarian cancer: Diagnostic pathway, surgical technique and outcomes

• Incidence of PH/HCL disease in patients with ovarian cancer is 14.3%.
• The combination of CT scan and exploratory laparoscopy can identify 100% of ovarian cancer patients with PH-HCL disease.
• The surgery is safe and effective and contributes to 90% complete resection.
• No complication was specifically related to the PH/HCL.

ObjectiveTo report the surgical technique of ovarian cancer resection at the porta hepatis (PH) and hepato-celiac lymph nodes (HCL). To assess surgical and survival outcomes. Define the accuracy of an integrated diagnostic pathway.MethodsPatients with FIGO stage IIIC–IV ovarian cancer that underwent Visceral-Peritoneal Debulking (VPD). Data of patients with disease at the PH/HCL during VPD were extracted from our database. The CT scan findings were compared with the exploratory laparoscopy. Accuracy of CT scan, intra- and post-operative morbidity, rate of complete resection (CR), disease free and overall survival are reported.ResultsThirty one patients out of 216 (14.3%) had tumor at the PH and/or HCL. In 8 patients out of 31 (25.8%) it was only found with the aid of the exploratory laparoscopy. CR was achieved in 28 patients out of 31 (90.3%). Pathology confirmed disease in the PH/HCL specimens of all but one patient. Overall morbidity relating to the VPD was 29.2%. No complication was specifically related to the PH/HCL. Median disease free survival was 19 months and median overall survival was 42 months.ConclusionPH/HCL surgery was required in 15% of patients with FIGO stage IIIC–IV. The surgery was feasible, safe and significantly contributed to CR. CT scan failed to identify the disease in 31% of the patients. CT and laparoscopy correctly identified all patients.