Introduction/Background*Isolated lymph node recurrence (ILNR) in selected platinum-sensitive recurrent ovarian cancer (psROC) patients is a very infrequent event (12% to 37%) and represent a less aggressive and indolent pattern of ROC. ILNR best treatment is represented by secondary cytoreductive surgery (SCS) with laparotomic or laparoscopic approach, given its non-chemo-sensivity, in particular when occurs in psROC patients in a number of metastatic lymph-nodes ≤3. ILNR favourable prognosis is certified by a median post-relapse survival which is around 37 months and without a certain association with BRCA mutational status. The objective of this video-article is to show the laparoscopic treatment for ILNR.
Result(s)*A case of 68 years-old patient affected by psROC is reported. The woman previously underwent first line platinum-based chemotherapy and interval debulking surgery, followed by bevacizumab maintenance therapy. Follow-up CT scan revealed isolated lymphadenopathy in the left iliac-obturatory region. The video shows a laparoscopic salvage lymphadenectomy, with complete pelvic and aortic dissection. Obviously, the surgeon should be able to prevent and to manage severe vascular complications. It is mandatory to recognize any anatomical anomalies and expose the surgical field to prevent and repair retroperitoneal injuries. In this sense, a preoperative radiological workup is necessary to better localize the lymph node disease. The patient was discharged in the 2nd post-operative day without any intra/post-operative complication. The final histology revealed ROC in 1/19 pelvic and aortic nodes.
Conclusion*Salvage lymphadenectomy for ILNR represent a challenging situation and an accurate preoperative study in different clinical situations is essential according to the PFI, number and site of metastases and to the BRCA mutational status. In selected cases, lymphadenectomy performed in a referral centre for gynaecological oncology, with a minimally invasive laparoscopic approach, is a reliable surgical option and could represent a very good alternative to laparotomy.
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