647 Roux-en-y gastric bypass for complete cytoreduction in a patient with advanced ovarian cancer

Introduction/Background Epithelial ovarian cancer ranks fifth in cancer-related deaths among women and is the fourth-most common gynecologic malignancy. In high grade serous ovarian cancers (HGSC), tumoral invasion of the colonic segments, of the greater gastric curvature, of the small bowel and the hepatic or splenic structures can be observed. In such cases multiple visceral resections might be needed in order to achieve complete cytoreduction. Here, we present a case of HGSC with gastric outlet obstruction and transverse colon invasion. Methodology A 56-year-old patient was referred to the gynaecological oncology department with complaints of abdominal distension. Her past medical history was significant for hypothyroidism, venous insufficiency, diabetes mellitus and gout. The ultrasound revealed extensive abdominal ascites and an abdominal mass of approximately 20 cm, consistent with peritonitis carcinomatosa. The CA-125 level was 2794. The endoscopy and colonoscopy results were normal. She was scheduled for a debulking procedure. Results During the exploration, an ovarian mass of 20 cm on the right side and a mass of 6 cm on the left side were identified. A tumour of 10–15 cm was located between the transverse colon and the stomach, causing obstruction of the gastric outlet and the transverse colon. A debulking procedure was performed, including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, subtotal gastrectomy with RnY gastrojejunostomy, resection of a segment of the transverse colon, appendectomy, diaphragm stripping with repair of a 5 cm diaphragmatic defect, and appendectomy (figure 1). Frozen section analysis was reported as high-grade serous carcinoma. The patient was discharged on postoperative day nine. She received six cycles of chemotherapy. Conclusion Maximal effort cytoreductive procedures should be considered feasible in the modern surgical era, as they are accompanied by acceptable rates of perioperative morbidity. Hence, every effort should be made to perform them in the primary setting, rather than following neoadjuvant chemotherapy. Disclosures None.