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Lymph node recurrence superior to the renal vein is not uncommon and safe dissection of such metastases is technically challenging.1 In this video (video 1) we share our surgical technique for metastatic lymph node dissection at the level of the celiac trunk to make the procedure easier to perform. The key steps of the procedure (online supplemental tables 1 and 2) can be summarized as follows. First, free the caudal end of the metastatic lesion. The caudal end of the metastatic lesion was close to the splenic artery, one branch of the celiac trunk. Second, free the left lateral side of the metastatic lesion. The left lateral side of the metastatic lesion was close to the left gastric artery, another branch of the celiac trunk. Third, free the right lateral side of the metastatic lesion. The right lateral side of the metastatic lesion was firmly attached to the portal vein and the inferior vena cava. Fourth, free the dorsal side of the metastatic lesion. The dorsal side of the metastatic lesion was buried deep in the space between the inferior vena cava and the abdominal aorta. Fifth, free the cranial end of the metastatic lesion. The cranial end of the lesion was close to the common hepatic artery, the left hepatic artery, and the right hepatic artery. Finally, we resected the metastatic lymph nodes safely and the pathologic report confirmed the recurrence of high-grade serous ovarian cancer. The patient has received one cycle of carboplatin/paclitaxel combination therapy and is scheduled to receive carboplatin/paclitaxel/bevacizumab combination therapy for an additional five cycles plus bevacizumab maintenance therapy. In conclusion, transabdominal resection of the metastatic lesion at the level of the celiac trunk was achieved safely in a logical manner. The critical point of the procedure is to expose the key anatomic landmarks in the surrounding area (figure 1).
Supplemental material
Key anatomic structures surrounding the metastatic lymph nodes.
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Ethics approval
This study involved human participants and was approved by the Institutional Review Board of the Obstetrics and Gynecology Hospital of Fudan University (Approval number: 2022-13, approval date: 2022-01-24). Participants gave informed consent to participate in the study before taking part.
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Supplementary Data
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.
Footnotes
Collaborators Not applicable.
Contributors Conception and design: JL, WJ. Collection and assembly of data: JL, WJ. Data analysis and interpretation: all authors. Manuscript writing: JL, WJ. Final approval of manuscript: all authors.
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.