Introduction/Background To present in video format the most relevant performed procedures, step by step.

Methodology Current case was analysed in a restrospective analysis of 19 patients underwent PE for recurrent and bulky gynecologic cancer during last ten years. Pelvic exenteration is an ultraradical surgery and it is imperative a preoperative assessment to evaluate the indication for surgery.

A 60-year-old woman operated on 2014 by laparotomy presented endometrioid adenocarcinoma, IIIc1 FIGO stage (5/19 involved pelvic nodes, 0/45 paraa-ortic nodes). Adjuvant treatment was indicated with chemotherapy, concomitant with external radiation therapy and brachytherapy, with complete response. Two years later, in a CT control, a mass of 3,5 cm appears in the right pelvic side and another mass of the 1,3 cm in right kidney (renal cell carcinoma G1). Chemotherapy and radiation therapy directed at the area was performed.

Results In RMI control, six months later, the tumor had grown (size 5 cm) and extended to and fixed to the right pelvic side wall. PET-CT was applied, and it excluded extrapelvic disease so the patient was proposed to LEER in the right pelvic side and right nephrectomy. Preoperative femorofemoral crossover bypass grafts after aorta uni-iliac endovascular graft and anticoagulant therapy was performed by vascular surgeons. Three weeks later, LEER was performed. Even a correct proper performance, presence of severe arterial and venous thrombosis during postoperative period was reported with critical ischaemia of the right lower limb with distal necrosis. It was proposed the amputation of his right leg from mid-thigh level. The patient, admitted to Intensive Care Unit, had a shock, multiorgan failure, and death.

Conclusion LEER is a potential salvage treatment in selected patients with recurrent gynecologic malignancies, including those with pelvic side wall disease, traditionally not considered for surgical therapy. LEER could be the last possible treatment, but cancer morbility begins in operating room.

Disclosure Nothing to disclose