Introduction/Background Complete secondary debulking surgery for recurrent ovarian cancer presenting as isolated lymph node metastases has an acceptable morbidity, and is associated with a favorable long-term survival outcome. However, the resection of enlarged lymph nodes can result in severe intraoperative complications, including the laceration of major retroperitoneal vessels and increased blood loss. Here, we report the details of a surgical technique for the resection of metastatic para-aortic lymph nodes with involvement of the inferior vena cava (IVC) requiring partial resection of the IVC.
Methodology A 55-year-old woman was initially managed for FIGO stage IIIA1 (pT1c pN1; metastasis to right pelvic lymph node, M0) ovarian cancer at another hospital. At a follow-up, computed tomography examination revealed para-aortic adenopathy in the lateroaortic and retrocaval regions. No other lesions were observed. The patient subsequently underwent a secondary debulking surgery. During surgery, enlarged lymph nodes that had involved the IVC were identified. Therefore, an en bloc resection of the lymph nodes with the involved portion of the IVC was performed with the clamping of the IVC.
Results In this case, a partial resection of the IVC was performed to enable a complete cytoreduction without encroaching on the tumor planes. Consequently, the suprarenal and retrorenal para-aortic lymph nodes were safely removed and tumor involvement of the lymph nodes was histopathologically confirmed in all the patients. Serious intra or early postoperative complications were not noted.
Conclusion An en bloc resection of the para-aortic lymph nodes with the involved segment of the IVC can be adopted for the management of metastatic para-aortic lymph nodes in selected patients. In this Surgical Video Session, I am presenting the nuts and bolts of this surgical technique.
Disclosure Nothing to disclose
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