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

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ESGOOvarianCancerOPERATIVEREPORT.TheGuidelinesandAssuranceQualityCommittee

2

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 | esgo-guidelines@esgomail.org | Published October 2016 by European Society of Gynaecological Oncology | Copyrights: © European Society of Gynaecological Oncology | ESGO Operative Report_v2