Intraperitoneal (IP) chemotherapy in women with optimally debulked stage 3 ovarian cancer improves overall survival and progression-free survival, and its use has been encouraged in the adjuvant treatment of appropriately selected patients (Armstrong et al., 2006; Jaaback and Johnson, 2006). We describe a case in which a previously inserted adjustable gastric band was converted to an IP chemotherapy port during a laparotomy for advanced ovarian cancer

Cohen, P

Tan, J

Tucker, P

Gynecologic Oncology Reports

English

ResearchOnline@ND

The University of Notre Dame Australia ResearchOnline@ND Medical Papers and Journal Articles School of Medicine 2015 Conversion of a gastric band into an intraperitoneal port in a patient with optimally debulked stage 3C serous ovarian carcinoma P Tucker P Cohen The University of Notre Dame Australia, paul.cohen@nd.edu.au J Tan J Tan Follow this and additional works at: https://researchonline.nd.edu.au/med_article  Part of the Medicine and Health Sciences Commons  This article was originally published as: Tucker, P., Cohen, P., Tan, J., & Tan, J. (2015). Conversion of a gastric band into an intraperitoneal port in a patient with optimally debulked stage 3C serous ovarian carcinoma. Gynecologic Oncology Reports, 12, 75-76. Original article available here: 10.1016/j.gore.2015.03.008 This article is posted on ResearchOnline@ND at https://researchonline.nd.edu.au/med_article/812. For more information, please contact researchonline@nd.edu.au. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non-Commercial No Derivatives 4.0 International license (CC BY-NC-ND 4.0), which permits others to copy and redistribute the material in any medium or form, provided the original work is properly cited. See: https://creativecommons.org/licenses/by-nc-nd/4.0/    This article originally published in the Gynecologic Oncology Reports available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442664/   Tucker, P., Cohen, P., Tan, J., and Tan, J. (2015) Conversion of a gastric band into an intraperitoneal port in a patient with optimally debulked stage 3C serous ovarian carcinoma. Gynecologic Oncology Reports, 12, 75-76. DOI:  10.1016/j.gore.2015.03.008       Case ReportConversion of a gastric band into an intraperitoneal port in a patient withoptimally debulked stage 3C serous ovarian carcinomaPaige.E. Tucker ⁎, Paul.A. Cohen, Jeremy Tan, Jason TanSt John of God Hospital Subiaco, 12 Salvado Rd, Subiaco, WA 6008, Australiaa r t i c l e i n f oArticle history:Received 12 January 2015Accepted 22 March 2015Available online 28 March 2015Keywords:Ovarian cancerGastric bandIntraperitoneal chemotherapyIntraperitoneal portBariatric surgeryIntroductionIntraperitoneal (IP) chemotherapy in women with optimallydebulked stage 3 ovarian cancer improves overall survival andprogression-free survival, and its use has been encouraged in the adju-vant treatment of appropriately selected patients (Armstrong et al.,2006; Jaaback and Johnson, 2006).We describe a case in which a previ-ously inserted adjustable gastric band was converted to an IP chemo-therapy port during a laparotomy for advanced ovarian cancer.Case reportA 44 year old woman was referred with suspected metastatic ovari-an cancer and ascites. Her past medical history included a laparoscopyand insertion of an adjustable gastric band 12 years earlier, and totalhysterectomy and right salpingo-oophorectomy 6 years earlier for be-nign disease.At laparotomy there was a 3 cm left ovarian mass with pelvic sidewall and left ureteric involvement, large volume omental tumour andextensive miliary peritoneal disease. Adhesiolysis and ureterolysiswere performed followed by left infundibulopelvic ligament ligationand a radical left salpingo-oophorectomy. Frozen section reported anadenocarcinoma of ovarian origin. On assessment of the upperabdomen, the intraperitoneal tubing of the gastric band was encasedGynecologic Oncology Reports 12 (2015) 75–76⁎ Corresponding author. Fax: +61 8 9381 2006.E-mail addresses: paigetucker@iinet.net.au (P.E. Tucker), Paul.Cohen@sjog.org.au(P.A. Cohen), jthtan1@gmail.com (J. Tan), jasontan@me.com (J. Tan).by tumour and adherent omental metastases. To achieve optimalcytoreduction, and because of the potential difﬁculties associatedwith subsequent removal of the gastric band after IP chemotherapy,the device was removed. The omentum and gastric band tubingwere mobilised, the lesser sac was entered and the gastro-oesophageal junction identiﬁed. The band was released and cut (seeFig. 1) and the subcutaneous Infusaport section of the device wasretained and converted into an IP port (see Fig. 2). During closure, theretained Infusaport was tested for peritoneal infusion using heparinisedsaline. At the conclusion of the surgery the residual disease was 0.5 cmof miliary tumour.Histopathology conﬁrmed a FIGO stage 3C, high grade serous adeno-carcinomaof the ovary. The patient successfully completed 6 cycles of IPCisplatin 135 mg, IP Paclitaxel 125 mg and intravenous Paclitaxel225 mg without any adverse effects or delays in treatment. Therewere no difﬁculties in accessing the converted gastric band Infusaport,however it varied from other IP ports in that it's bulb was locatedmore deeply within the subcutaneous tissue and required a two ﬁngerstabilisation technique for use. The port was removed after completionof chemotherapy (see Fig. 3) and histopathology conﬁrmed no seedingof tumour along the tubing.DiscussionObesity is a public health issue of epidemic proportions and there is awell-recognised association between obesity and certain ovarian cancersubtypes (Olsen et al., 2013). As the number of bariatric surgical proce-dures increases in line with obesity rates, gynecologic oncologists maymore frequently encounter gastric bands at laparotomy in patientswith advanced ovarian cancer. Abdominal complaints after bariatricsurgery, such as weight gain, dyspepsia and distension, are often ex-plained by surgical complications or poor eating habits. However, in amiddle-aged woman who presents with abdominal distension follow-ing a gastric banding procedure, ovarian disorders must be consideredin the differential diagnosis (Tenhagen et al., 2012).The decision to separate the subcutaneous Infusaport from the in-ﬂatable band piece and convert it to an IP port at the time of surgeryspared our patient further surgery and the need for a new port. The re-moval of the adjustable part of the band was essential to eliminate therisk of future complications, such as gastric erosion or slippage (Snowand Severson, 2011), which would be difﬁcult to manage surgically fol-lowing intraperitoneal chemotherapy due to the high likelihood ofadhesions.Contents lists available at ScienceDirectGynecologic Oncology Reportsj ourna l homepage: www.e lsev ie r .com/ locate /gorehttp://dx.doi.org/10.1016/j.gore.2015.03.0082352-5789/© 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Removal of the gastric bandwas required in order to achieve optimalcytoreduction and the histopathology conﬁrmed that the tissue adher-ent to the band contained malignant cells. Leaving the Infusaport insitu may carry a potential risk of subcutaneous metastasis as malignantcells may have seeded along the tubing to the subcutaneous tissues ad-jacent to the Infusaport. The patient's Infusaport site will be monitoredclosely for this during her follow-up.This is the ﬁrst reported case of a gastric band being adherent toupper abdominal metastases from an ovarian carcinoma and describesa novel technique of conversion of a gastric band to an IP chemotherapyport.ConsentWritten informed consent was obtained from the patient for publi-cation of this case report and accompanying images. A copy of the writ-ten consent is available for review by the Editor-in-Chief of this journalon request.Conﬂicts of interestNo authors have funding or conﬂicts of interest to declare.ReferencesArmstrong, D.K., Bundy, B., Wenzel, L., Huang, H., Baergen, R., Lele, S., 2006. Intraperitone-al cisplatin and paclitaxel in ovarian cancer. N. Engl. J. Med. 354, 34–43. http://dx.doi.org/10.1530/ERC-12-0395.Jaaback, K., Johnson, N., 2006. Intraperitoneal chemotherapy for the initial managementof primary epithelial ovarian cancer. Cochrane Database Syst. Rev. (1) http://dx.doi.org/10.1002/14651858.Olsen, C., Nagle, C., Whiteman, D., Ness, R., Pearce, C., Pike, M., et al., 2013. Obesity and riskof ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consor-tium. Endocr. Relat. Cancer 20, 251–262. http://dx.doi.org/10.1530/ERC-12-0395.Snow, J., Severson, P., 2011. Complications of adjustable gastric banding. Surg. Clin. N. Am.91 (6), 1249–1264. http://dx.doi.org/10.1016/j.suc.2011.08.008.Tenhagen, M1., van Ramshorst, G.H., Remmink, A.J., Cense, H.A., 2012. Increasing abdom-inal girth in a female patient with a gastric band. Ned. Tijdschr. Geneeskd. 156 (21),A4668.Fig. 1. Removed portion of gastric band.Fig. 2. Schematic diagram of the procedure.Fig. 3. Infusaport portion of gastric band following removal.76 P.E. Tucker et al. / Gynecologic Oncology Reports 12 (2015) 75–76

Conversion of a gastric band into an intraperitoneal port in a patient with optimally debulked stage 3C serous ovarian carcinoma

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Conversion of a gastric band into an intraperitoneal port in a patient with optimally debulked stage 3C serous ovarian carcinoma

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