Cytoreductive surgery: Right upper abdomen—Liver, gallbladder, and porta hepatis

Advanced stages of ovarian cancer frequently involve right upper quadrant abdominal structures, including the liver, gallbladder, and hepatoduodenal ligament [1]. is is not surprising given the high incidence of extrapelvic disease among patients with primary ovarian malignancies and the typical pattern of peritoneal tumor dissemination along the right paracolic gutter to the right upper quadrant. At the time of primary cytoreductive surgery, the right hemidiaphragm and liver surface are oen noted to harbor metastatic disease in patients with advanced-stage ovarian cancer [2-5]. Preoperative radiographic staging may reveal that the liver parenchyma, gallbladder, and hepatoduodenal ligament (porta hepatis) are involved. Furthermore, ovarian cancer may recur at these sites, particularly aer an incomplete primary resection or even aer complete cytoreduction [6]. Multiple studies have specically addressed the feasibility and associated long-term survival of radical resection of synchronous and metachronous peritoneal metastases in the right upper quadrant [2,7-9]. Nevertheless, ovarian cancer metastases involving hepatobiliary structures are frequently cited as principal impediments to achieving optimal and/or complete cytoreduction. Safe and eective operative and perioperative management of such disease requires that the surgeon charged with managing disease in the right upper quadrant of the abdomen be intimately familiar with the regional anatomy and procient in both excisional and ablative techniques of cancer extirpation.