Article Text

Vessel-preserving en bloc adventitial excision of a bulky tumor involving the iliac artery
  1. Ghanim Khatib1,
  2. Yavuz Cicek1,
  3. Yasin Guzel2,
  4. Umran Kucukgoz Gulec1,
  5. Ahmet Baris Güzel1 and
  6. Mehmet Ali Vardar1
  1. 1 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
  2. 2 Department of Vascular Surgery, Cukurova University Faculty of Medicine, Adana, Turkey
  1. Correspondence to Dr Ghanim Khatib, Obstetrics and Gynecology Department, Division of Gynecologic Oncology, Cukurova University Faculty of Medicine, Adana 01330, Turkey; ghanim.khatib{at}

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In some cases of locally advanced ovarian cancer, iliac vessels are infiltrated or are tightly adhered. In particular, involvement of the external iliac vessels is a rare situation.1 These cases are mostly accepted as being inoperable and are referred for neoadjuvant chemotherapy. However, vessel resection and reconstruction with vascular grafts is feasible to obtain complete resection in such cases.2 Herein, we present a case of a 46-year-old woman admitted with abdominal pain. Pre-surgical examination revealed a fixed, solid-weighted adnexal mass suspicious for invasion to the adjacent structures. No further lesions were identified on pre-surgical imaging. At laparotomy, the right lower abdomen-pelvis was filled with a firm, fixed mass which involved the right abdominopelvic peritoneum, adnexa, uterus, terminal ileum, and caecum. The invaded bowels were detached from the mass, then right hemicolectomy and ileocolic anastomosis were performed. Thereafter, en bloc resection of the main mass including total hysterectomy and salpingo-oophorectomy was carried out. The frozen section results revealed a primary endometrioid ovarian carcinoma. Right pelvic lymph nodes were conglomerated, tightly adhered to the iliac vessels, and conjoined with the rest of the mass, especially at the distal part towards the right femoral channel entry in a manner that did not allow identification of the vessels at this point. Moreover, the tumorous mass fully surrounded the external iliac artery and invaded its adventitial layer from the iliac bifurcation to the femoral channel entry.

Right lymph node dissection was started at a proximal level to identify the common iliac artery and vein first, and then the proximal parts of the external and internal iliac vessels. The formed bulky mass (conglomerated nodes and mass) was attached firmly to the iliac vessels. It was separated from the external iliac vein, internal iliac artery and vein with careful dissection using right-angle and cautery. Nevertheless, it was observed that the adventitial layer of the external iliac artery was tightly adhered and infiltrated. Therefore, a similar dissection method was not possible, and the mass was excised via stripping the adventitial layer of the artery. After completing the procedure, vascular surgery consultation was requested, and no further interventions were recommended. By means of this method the goal of “no macroscopic disease” was achieved without the need for arterial resection and vascular grafts. The surgical materials and instruments used are provided in Online Supplemental File 1.

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Video 1

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Contributors GK, YC: performed the surgery. GK: wrote the article and prepared the video. YG: checked the artery condition intraoperatively. UKG, ABG, MAV: reviewed the article and video. GK, YC, YG, UKG, ABG, MAV: confirmed the final version of the article and video.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.