Retroperitoneal pelvic invasion in ovarian cancer: Possible modes of spread and survival impact

Stanislav Slavchev, Angel Yordanov


Ovarian cancer is the second-most common malignancy and the leading cause of death in women who develop cancers of gynaecologic origin and it spread primarily by direct exfoliation of cells along the peritoneal surface. Interesting fact, although not well studied, is that these tumours invade the mesothelium but very rarely they invade the peritoneum deeper through direct extension.

To study the retroperitoneal pelvic invasion in parametrial ligaments and vagina in patients undergoing surgery for advanced epithelial ovarian carcinoma and the survival impact of it.

The study included 59 patients with advanced epithelial ovarian cancer that underwent radical hysterectomy during the 2004–2009 period. For the purpose of this study histopathologic examination was performed for the parametrial ligaments and vagina with inspection of the surgical resection lines.

Retroperitoneal pelvic invasion was found in 42.4 per cent of the cases, involving different depths of parametrial ligaments and/or vaginal spread, and is associated to worse survival outcomes.

Retroperitoneal pelvic invasion is not a rare phenomenon and seems to be a feature of the more aggressive tumours. In the cases of distal retroperitoneal pelvic invasion (vaginal) the patients’ 5-year survival rate is similar to that of the stage IV ovarian cancer patients.
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