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Abstract：
OBJECTIVE: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery.
METHODS: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC-IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022.
RESULTS: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease. Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9-33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3-14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6-32.9).
CONCLUSIONS: Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.
METHODS: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC-IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022.
RESULTS: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease. Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9-33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3-14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6-32.9).
CONCLUSIONS: Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.
摘要：
目的：胃上小囊（SGLS）转移不仅隐匿，而且是卵巢癌完全切除的障碍。我们描述了接受减积手术的SGLS病患者队列。
方法：我们确定了2018年1月至2022年8月在我们机构接受SGLS疾病评估和最终切除作为IIIC-IVB期高级别上皮性卵巢癌细胞减灭术的一部分的所有患者。
结果：286例患者中有33例（11.5%）接受了SGLS疾病的切除。33例患者中有4例（12.1%）通过术前影像学检查发现SGLS转移。中位腹膜癌指数得分为22(范围，9-33).通过手术探查,转移经常见于右膈（100%），肝肾隐窝（97%），小网膜(81.8%)，左隔膜（78.8%），结肠大网膜(75.8%)，前横结肠系膜（72.7%），脾门(63.6%),肝圆韧带(60.6%),胆囊窝(51.5%)。33例患者中有6例(18.2%)小网膜正常,尽管SGLS内转移。共有54.5%的患者接受了复杂手术(手术复杂性评分；中位数，8;范围,3-14).19例（57.6%）患者获得完全切除。未发生与SGLS病切除有关的并发症。无进展生存期的中位数为24.8个月（95％置信区间=16.6-32.9）。
结论：SGLS转移在晚期卵巢癌中并不少见，特别是那些疾病广泛传播的人。术前影像学很少发现该隐窝中的疾病，值得进行系统的手术探索以实现完全的细胞减灭术。
方法：我们确定了2018年1月至2022年8月在我们机构接受SGLS疾病评估和最终切除作为IIIC-IVB期高级别上皮性卵巢癌细胞减灭术的一部分的所有患者。
结果：286例患者中有33例（11.5%）接受了SGLS疾病的切除。33例患者中有4例（12.1%）通过术前影像学检查发现SGLS转移。中位腹膜癌指数得分为22(范围，9-33).通过手术探查,转移经常见于右膈（100%），肝肾隐窝（97%），小网膜(81.8%)，左隔膜（78.8%），结肠大网膜(75.8%)，前横结肠系膜（72.7%），脾门(63.6%),肝圆韧带(60.6%),胆囊窝(51.5%)。33例患者中有6例(18.2%)小网膜正常,尽管SGLS内转移。共有54.5%的患者接受了复杂手术(手术复杂性评分；中位数，8;范围,3-14).19例（57.6%）患者获得完全切除。未发生与SGLS病切除有关的并发症。无进展生存期的中位数为24.8个月（95％置信区间=16.6-32.9）。
结论：SGLS转移在晚期卵巢癌中并不少见，特别是那些疾病广泛传播的人。术前影像学很少发现该隐窝中的疾病，值得进行系统的手术探索以实现完全的细胞减灭术。
