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2022-VA-1166-ESGO Suspicious lymph nodes in advanced ovarian cancer: debulking surgery
  1. Cristina Celada Castro1,
  2. Joana Oliveira2,
  3. Kristina Agababyan3,
  4. Juan Gilabert Aguilar4 and
  5. Juan Gilabert Estelles5
  1. 1Gynecology and obstetrics, Hospital Universitari de Vic, Vic (Barcelona), Spain
  2. 2Gynecology Department, University Hospital Center of Coimbra, Coimbra, Portugal
  3. 3Endoscopy and Gynecologic Oncology Unit, Hospital General Universitario de Valencia, Valencia, Spain
  4. 4European Gynecology Endoscopy School (E.G.E.S.-Valencia), Valencia, Spain
  5. 5Gynecology and Obstetrics, Endoscopy and Gynecologic Oncology Unit, Hospital General Universitario de Valencia, Valencia, Spain


Introduction/Background Lymph node staging in ovarian cancer is surgical and is performed by pelvic and para-aortic lymphadenectomy. However, it has not been observed that systematic pelvic and para-aortic lymphadenectomy in advanced ovarian cancer without clinically suspicious lymph nodes is associated with an improvement in patient survival. Nevertheless, to improve the prognosis of patients with advanced ovarian cancer is important to eradicate cancer cells completely and there is sufficient evidence to perform lymph node debulking when there are clinically suspicious nodes. The objective of this video is to highlight the importance of to perform a complete radical ovarian surgery that includes lymph node debulking of suspicious nodes.

Methodology We present the interval surgery of a 61-year-old woman, who was found to have an advanced serous papillary ovarian cancer, described as FIGO IIIC.

Results During the exploratory laparoscopy an important adenopathic lump was observed above inferior mesenteric, fixed to the vena cava, with a mass effect, unresectable from the outset. The surface of the spleen suggested the presence of metastatic implants; small subdiaphragmatic and peritoneal implants were observed, so treatment with neoadjuvant chemotherapy was decided. After neoadjuvant treatment the PET-CT shows an interaortocaval retroperitoneal hypermetabolic adenopathy, suggestive of tumour infiltration. No more morphometabolic lesions were observed, so interval surgery was decided. Interval surgery was uneventful, and lymph node debulking of the inter-aortocaval adenopathy was also performed. For this, a careful dissection of the adventitia of the aorta was performed until accessing the interaortocaval plane and locating the adenopathy (located between the exit of the inferior mesenteric artery and the crossing of the left renal vein). A complete exeresis of the adenopathy was achieved without incident

Conclusion This video proves that the surgical procedure of debulking surgery of suspicious lymph nodes is feasible without major complications if performed by experienced gynaeco-oncologists.

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