ESGO Ovarian Cancer OPERATIVE REPORT · ESGO Ovarian Cancer OPERATIVE REPORT. The Guidelines and...

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ESGO Ovarian Cancer OPERATIVE REPORT ESGO Guidelines, Recommendations and Assurance Quality Committee 1 1. Surgery Data 1 st Surgeon Dr: 2 nd Surgeon Dr: Type of Tumor: Ca-125 UI/ml at Surgery: Suspected stage IV ? Extra abdominal lymph nodes 2.Surgical Approach and Findings Volumen of Ascites: Frozen Section: Frozen Section Diagnosis: Tumor involvement Right ovary Uterus Right gutter Small bowel mesentery Liver parenchymal Celiac nodes Left ovary Bladder/ ureter Left gutter Large bowel mesentery Lesser omentum Abdominal wall Right tube Sigmoid-Rectum Small bowel Paraaortic nodes Stomach Skin Left tube Recto-vaginal septum Omentum Right diaphragm Pancreas Pericardiophrenic nodes Douglas Pelvic wall Large bowel Left diaphragm Spleen Inguinal nodes Vagina Pelvic nodes Appendix Liver surface Hepatic hilum nodes Specify other: Hospital-Institution: City: Country: Identification code (for internal use only): Date of birth: Date of Surgery: 0 Central 1 Right upper 2 Epigastrium 3 Left upper 4 Left flank 5 Left lower 6 Pelvis 7 Right lower 8 Right flank 9 Upper jejunum 10 Lower jejunum 11 Upper ileum 12 Lower ileum PCI 0 Interaortocava/preaort. 1 Porta Hepatis 2 Celiac Axis 3 Suprarenal/Splenic 4 Left aortic 5 Left common iliac 6 Left ext iliac 7 Left inguinal 9 Right ext iliac 10 Right common iliac 11 Pre-Paracava 12 Right cardio phrenic 13 Left cardio phrenic Aim of Surgery: IfYes, please select: Skin Lung Pleura Abdominal wall Liver Parenchyma Spleen Parenchyma Other sites: Approach: Type of procedure: PRE POST PERITONEAL CANCER INDEX 8 Right inguinal + R+ R0 +: Suspicious or Positive R+: Residual disease R0: No residual disease RETROPERITONEAL DISEASE Pf Status-ECOG guidelines.esgo.org | [email protected] | Published October 2016 by European Society of Gynaecological Oncology | Copyrights: © European Society of Gynaecological Oncology | ESGO Operative Report_v2

Transcript of ESGO Ovarian Cancer OPERATIVE REPORT · ESGO Ovarian Cancer OPERATIVE REPORT. The Guidelines and...

ESGOOvarianCancerOPERATIVEREPORTESGO Guidelines, RecommendationsandAssuranceQualityCommittee

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1. SurgeryData 1st SurgeonDr: 2nd Surgeon Dr: TypeofTumor:

Ca-125UI/mlatSurgery: SuspectedstageIV? Extraabdominallymphnodes

2.Surgical Approach and Findings

VolumenofAscites: FrozenSection: FrozenSectionDiagnosis:

Tumorinvolvement

Rightovary Uterus Rightgutter Smallbowelmesentery Liverparenchymal Celiac nodes

Leftovary Bladder/ureter Leftgutter Largebowelmesentery Lesseromentum Abdominalwall

Righttube Sigmoid-Rectum Smallbowel Paraaorticnodes Stomach Skin

Lefttube Recto-vaginalseptum Omentum Right diaphragm Pancreas Pericardiophrenicnodes

Douglas Pelvicwall Largebowel Leftdiaphragm Spleen Inguinalnodes

Vagina Pelvicnodes Appendix Liversurface Hepatichilumnodes Specifyother:

Hospital-Institution: City: Country:Identificationcode (for internal use only): Dateofbirth: DateofSurgery:

0Central1Rightupper2Epigastrium3Leftupper4Leftflank5Leftlower6Pelvis7Rightlower8Rightflank9Upperjejunum10Lowerjejunum11Upperileum12Lowerileum

PCI

0 Interaortocava/preaort.1 PortaHepatis2CeliacAxis3Suprarenal/Splenic4Left aortic5 Left common iliac6 Leftext iliac7 Left inguinal

9 Rightext iliac10Rightcommon iliac11Pre-Paracava12Right cardio phrenic13Left cardio phrenic

AimofSurgery:

IfYes,pleaseselect: SkinLungPleura

Abdominal wall Liver Parenchyma Spleen Parenchyma Other sites:

Approach: Type of procedure:

PRE POST

PERITONEAL CANCER INDEX

8 Right inguinal

+ R+ R0

+: Suspicious or Positive R+: Residual disease R0: No residual disease

RETROPERITONEAL DISEASE

Pf Status-ECOG

guidelines.esgo.org | [email protected] | Published October 2016 by European Society of Gynaecological Oncology | Copyrights: © European Society of Gynaecological Oncology | ESGO Operative Report_v2

ESGOOvarianCancerOPERATIVEREPORT.TheGuidelinesandAssuranceQualityCommittee

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3. SurgicalProcedures.

Hysterectomy Pelvicnodes

Smallbowelresection

Livercapsuleresection

Unilateralsalpingooophorectomy

Paraaorticnodes

Largebowelresection

AtypicalLiverresection

Bilateralsalpingooophorectomy

InguinalnodesAppendicectomy

Parcialhepatectomy

Smallbowelmesentery

Pericardiophrenicnodes

Peritonectomy gutters

Cholecistectomy

Ureteralresection

Hepatichilumnodes

Diaphragmaticstripping Peritonectomy Morrison

Colorectalresection

Celiacaxis

Diaphragmaticresection

Resectionlesseromentum

Partialcystectomy Infracolicomentectomy Splenectomy

Partialgastrectomy

Pelvicperitonectomy Radicalomentectomy Partialpancreatectomy Other:

Nº anastomoses: Residualsmallbowel(cm): StomaFormation: Type:

Otherprocedures: IP-Port-a-cath IV-Port-a-cath Abdominalwallresection Meshplacement VATS HIPEC

Residualdisease(Intra-abdominal): No macroscopic 0.1-0.5cm 0.6-1cm >1cm

Anycommentthathasnotbeen specified:

Location/size of residual disease:

Durationoftheprocedure(minutes): EstimatedBloodLoss(cc): NºRBCunitstransfused:Severecomplicationsduringtheoperation:PatientwasbroughttoICUwith: NGtube FoleyCath EpiduralCath Endotrachealtube Chesttube Drain/s:(n)

Dateofcompletionofthisoperativereport: OperativeReportfilledbyDr:

Definitive Temporary

Residualdisease(Extra-abdominal): No macroscopic 0.1-0.5cm 0.6-1cm >1cm

Pelvic procedures Medium abdomen procedures Upper abdomen procedures

5ƛŦdzǎŜ {ŜNJƻǎŀƭ [ƛǾŜr tŀƴŎNJŜŀs {dzLJNJŀŘƛŀLJƘNJŀƎ. /ŜƭƛŀŎ !ȄƛǎReason of Residual : Other Hepatic hilum

guidelines.esgo.org | [email protected] | Published October 2016 by European Society of Gynaecological Oncology | Copyrights: © European Society of Gynaecological Oncology | ESGO Operative Report_v2