Introduction/Background 10–15% of endometrial cancers are advanced but are responsible for more than half of the recurrences and deaths.The benefit in survival of cytoreduction surgery imitating advanced ovarian cancer is suggested and complete resection and lymphadenectomy up to the left renal vein is mandatory (Havrilesky et al. 2015). In stages IIIC the size of the lymph nodes technically conditions its possibility of resection and this challenging surgical effort often is performed by laparotomy.
We suggest benefits and feasibility of conventional laparoscopic approach due to its high definition and technical accuracy and this is the aim of this surgical video which describes the entire removal of precaval bulky nodes by conventional laparoscopic extraperitoneal approach during standard aortic lymphadenectomy.
Methodology A 49-year old woman was referred for incidental endometrial cancer after hysterectomy; 3.5x2.5 cm sized endometrioid carcinoma invading more than 50% of the myometrium with ILV positive and suspicious evidence of metastasis in pelvic and paraaortic lymph nodes in TC scan.Thus, following ESGO guidelines, surgical staging and debulking was planned through minimal invasive technique.
Results After extraperitoneal paraaortic space exposure, enlarged pelvic, left aortic and precaval lymph nodes were confirmed. A primary complete laparoscopic lymphadenectomy was performed up to the left renal vein using an harmonic sealing device. Right ureter was firmly attached to infra mesenteric precaval 2–3 cm bulky nodes. Ureter was released, and bulky nodes resection was accomplished by careful rome dissection.
The surgery also comprised other transperitoneal procedures, which are not included in this video (Pelvic lymphadenectomy and ooforectomy). The surgery was carried out in Donostia Hospital (Spain) by a senior oncological surgeon and a fellow. The final biopsy confirmed metastasis in pelvic and paraortic nodes (FIGO IIIC2) and extensive LVI.
Conclusion Laparoscopic complete resection of bulky precaval nodes in advanced endometrial cancer is feasible and provides desirable accuracy in trained surgeons hands.
Disclosure Nothing to disclose
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