Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent ovarian cancer.

Advanced primary and recurrent ovarian cancer within the pelvis presents a difficult oncologic problem in management. Based on a failure analysis of ovarian cancer, a new procedure was devised for the complete surgical removal of all visceral and parietal pelvic surfaces. Resections included the uterus, ovaries, rectosigmoid colon, and the complete pelvic peritoneum, including the cul-de-sac of Douglas. An immediate low rectal anastomosis with a circular stapler was utilized in all patients. Intraperitoneal chemotherapy was employed on postoperative days 1-5 to prevent further implantation of cancer cells. The technical experience with 12 women is reported. The circular stapler resulted in no anastomotic leakage and no anastomotic bleeding. There were no postoperative deaths. These results suggest that complete pelvic peritonectomy combined with early postoperative intraperitoneal chemotherapy carries an acceptable morbidity and mortality, and is a new treatment strategy that may be considered for advanced malignancy in the pelvic cavity. This surgical technique may be pursued in an attempt to optimize the management of ovarian cancer with peritoneal seeding.