Key information (information to look for and pay attention to and to document with regard to collecting pertinent information about the patient's cancer):
Surgeon's comments on involvement of adjacent organs and structures; fixation of tumor; invasion of major blood vessels; physical description of organ (hard, leathery, wine sack appearance); depth of organ cavity, for example,"sounding" of uterus; tumor encompassing nerves or blood vessels; fixed or matted lymph nodes; tissues or areas involved that are not included in the pathology specimen, names of organs or tissues removed; number, site, and involvement of lymph nodes removed; anatomic site and name of all involved lymph nodes not removed during the resection; site and description of any gross tumor not removed, any tumor on or in the liver that is not biopsied, appearance and size of organ, extent of involvement of other organs in same body cavity tumor implants, seeding, implants, talcum powder appearance, encasement, nodularity of viscera, frozen pelvis, which organs were removed, results of examination under anesthesia.
Examination Under Anesthesia (EUA)
Intraoperative Evaluation of Diaphragm
Visual and manual inspection of the diaphragm, particularly the right leaf, during laparotomy for treatment of ovarian cancer. Optimally, the intraoperative evaluation of the diaphragm should occur prior to any dissection of pelvic organs. Evaluation of the diaphragm is an important part of accurate staging of ovarian cancer.
Evaluation of the contents of the abdomen for the purpose of determining the extent of disease. A staging laparotomy is not routinely done for Hodgkin disease, unless the opportunity for obtaining better staging information exceeds the risk of operative morbidity. An adequate staging laparotomy includes abdominal exploration, wedge and needle biopsies of the liver, multiple lymph node biopsies, bone marrow biopsy, and splenectomy. Staging laparotomy is considered a diagnostic procedure rather than surgical treatment. The staging laparotomy is an opportunity to identify landmarks within the abdomen, such as unresectable large nodes or the splenic pedicle, which will affect the design of radiation treatment for the patient. Precise staging is important for Hodgkin disease and to a lesser extent non-Hodgkin lymphoma.
Staging Procedures for Ovary
Adequate staging procedures during laparotomy should include evaluation of the undersurface of the diaphragm, pelvic and abdominal peritoneum biopsies, pelvic and paraaortic lymph node biopsies, peritoneal washings, and biopsies of any suspicious nodules or masses. The surgeon's report should reflect the results of these procedures.
Radical orchiectomy with laparotomy and removal of bilateral retroperitoneal lymph nodes to determine the histologic cell type, remove the primary tumor, and evaluate the lymph nodes of the retroperitoneum. Surgical staging also provides debulking of tumor if lymph nodes are positive. Also called: retoperitoneal lymphadenectomy.