Introduction/Background To demonstrate the technique of resection of enlarged retrocaval lymph nodes in a patient undergoing cytoreductive surgery for recurrent ovarian cancer.
Methodology A 70-year-old patient undergoing follow up for previously treated stage IIIA1 serous carcinoma of the ovary was found to have enlarged retrocaval lymph nodes extending from the level of right common iliac vein to the level of the right renal artery. A PET-CT scan showed no evidence of peritoneal or extra-abdominal disease.
Results The patient underwent a midline laparotomy. Exploration of the abdomen showed no evidence of peritoneal disease. Ascending colon and mesentery of the small bowel was mobilised. The second and third part of the duodenum was mobilised and inferior vena cava (IVC) was exposed. Renal veins were identified and exposed bilaterally. Right renal artery and ureter were identified and mobilised. IVC was mobilised from the anterior surface of the tumour from the level of the right common iliac artery to the level of the right renal artery and the aorta. Lumbar veins were identified and ligated. Tumour was mobilised from the anterior aspect of the vertebral bodies and removed using bipolar diathermy. Complete tumour resection was achieved.
Postoperative recovery was uncomplicated and the patient was discharged home after 5 days. Histological examination of the retrocaval lymph nodes showed metastatic high grade serous carcinoma.
Conclusion Resection of enlarged retrocaval lymph nodes is feasible. Careful consideration of the relevant surgical anatomy is required and steps should be in place to deal with complications if necessary.
Disclosure Nothing to disclose
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