Performing right upper abdominal cytoreduction: anatomical planes, liver mobilization and occult spaces

Optimal Cytoreductive Surgery (CRS) is the cornerstone for curative therapy for advanced ovarian malignancies and other peritoneal surface malignancies (PSMs) and achieving a CC-0 score is the principal prognostic factor for long term survival. The right upper abdomen is one of the most technically demanding regions because disease may be hidden beneath the right liver, along the diaphragm, in Morrison's pouch, over Glisson's capsule, and around the hepato-caval groove. Complete liver mobilisation is therefore both an oncologic manoeuvre and a vascular-risk manoeuvre.

To define and describe the surgical anatomy of the right upper abdomen and discuss the intricacies of dissecting this region.

This is a retrospective analysis of the prospectively maintained database at Department of Surgical Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, New Delhi. 205 patients undergoing Cytoreductive Surgery (CRS) with liver mobilization for Ovarian Malignancy were reviewed and perioperative details regarding Upper Abdominal CRS, injuries in the hepato-caval triangle and postoperative complications were recorded.

Among 600 patients undergoing CRS for ovarian malignancies between January 2014 and December 2025, liver mobilization was performed in 205 patients. Most underwent interval CRS after NACT (57.6%). Optimal cytoreduction was achieved in 194 patients (94.6%). RHV injury occurred in 9 patients (4.4%), predominantly during the initial 100 cases.

This article describes a structured approach to right upper abdominal CRS, emphasizing liver mobilisation, exposure of occult spaces, and safe dissection around the hepato-caval junction. Ray's triangle is presented as a practical danger-zone concept that helps the surgeon understand and avoid RHV-IVC injury during complete mobilisation.