Introduction/Background Current randomized studies have pointed out the impact of

Secondary cytoreductive surgery in recurrent ovarian cancer.

In patients who relapse after a disease-free period greater than 6 months, the general state (ECOG 0), the result R0

of the first surgery and the presence of less than 500 ml ascites (AGO scoring criteria) are ideal criteria, but non-exclusive, to assess the possibility of secondary cytoreduction. If an R0 is achieved after the second cytoreduction following these criteria, disease-free and overall survival are increased.

Endometrioid ovarian cancer accounts about 10% of all epithelial tumors. In most cases, it develops in perimenopausal women and is diagnosed at early stage. In approximately 42% of the cases, endometrioid ovarian cancer is associated with ovarian and/or pelvic endometriosis.

Methodology We present a case report of a 43 years-old patient with a recurrent endometrioid ovarian cancer. Previously, she was diagnosed with endometriosis.

2019, primary citoreductive surgery, FIGO IIIA2, endometrioid ovarian cancer. She completed six cycles of adjuvant chemotherapy with Carboplatin and Paclitaxel.

In november/2021 she presented a multiple nodal recurrence in the left iliac and para-Aortic region.

She underwent secondary debulking surgery with ligation of left hypogastric vessels.

Results Secondary debulking surgery.

PCI 10. Multiple nodal recurrence (left hypogastric artery, left internal obturator).

Surgery time 10h 50 min.

Blood transfusion 5 Units of red blood cells and 2 of plasma.

R0 achieved.

BRCA1, BRCA2 and CHEK2 negative.

Post-operative complication neuropathic pain in left leg.

Nowadays she is alive.

Conclusion Secondary debulking surgery can be considered a feasible and therapeutic option for the management of recurrences, although long-term follow-ups are necessary to evaluate the overall oncologic outcomes of this procedure.

Interruption of the hypogastric artery by ligation can result in ischemic complications, but it can be considered in case of an uncontrollable major bleeding or in the context of a R0 surgery.

Disclosures Some authors suggested to consider to avoid systematic lymph node dissection in patients affected by early-stage low-grade endometrioid cancer and SEO-EC without apparent lymph node involvement at pre-operative imaging.

In this case, despite the patient underwent complete surgery with systematic pelvic and para-aortic lymphadenectomy, and completed six cycles of adjuvant chemotherapy with Carboplatin and Paclitaxel, she had nodal recurrence.