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Abstract
Introduction/Background Lymphadenectomy is performed during surgical treatment of gynaecological malignancies for their therapeutic and prognostic significance. These procedures are performed close to multiple vascular structures with high risk of serious intraoperative injuries and bleeding. Many retrospective studies showed the advantages of surgery in patients with long disease-free interval, resectable disease, limited number of metastatic sites, absence of ascites, and good performance status. However, the frequency of isolated lymph node recurrence is actually rare, between 1–6%. In these patients, surgery could be of particular benefit.
Methodology We discuss case of eradication of isolated para-aortic lymph nodal recurrence, after 22 months, in a patient diagnosed with stage 3B vaginal clear cell carcinoma and treated with primary chemo-radiotherapy. During routine follow-up scans, an enlarged left Para-aortic lymph node detected which was showed to be active disease on PET/CT scan with no evidence of local recurrence in the pelvis. After MDT discussion and discussion of the management options with the patient, she opted for surgery.
The patient had Midline laparotomy Para-aortic lymph nodes were found densely adherent to the aorto-caval ligament/bone. Complete infra-renal Para-aortic lymphadenectomy was done. No intraoperative complications and the recovery period was unremarkable. The Histology result revealed that 2/7 lymph nodes are positive. The postoperative MDT meeting decision was to consider adjuvant PA lymph node radiotherapy. The patient has completed adjuvant radiotherapy to the Para-aortic strip. Postoperative CT chest, abdomen pelvis will be arranged as baseline to monitor the progress.
Conclusion From our clinical point of view, surgery is considered a safe and effective option for management of isolated Para-aortic lymph nodal recurrence, with a significantly less postoperative hospital stay and low morbidity. However; it should be reserved for oncologic surgeons trained in major surgical procedures. Additionally; large multi-centre randomized clinical trials are needed to follow up the overall outcomes of this procedure.
Disclosures Nothing to disclose.
PET CT scan, showed active disesase in PALN
Showed infra renal para-aortic lymphadenectomy and aorto-caval space after eradication of nodal reccurence