Introduction/Background Background: Ovarian cancer relapse is a challenging situation that requires multidisciplinary approach. Debulking in secondary or subsequent relapses should be considered in highly selected cases, based on performance status, tumour biology and location of recurrence, as long as a complete tumour resection can be achieved.

Methodology In this video, we present a case of ovarian cancer relapse in which tertiary debulking is performed.

Results This is a 55-year-old patient, diagnosed with stage IIIC high-grade serous ovarian carcinoma in 2019, initially treated with neoadjuvant chemotherapy (Carboplatin-Paclitaxel) followed by interval debulking surgery (R0). Subsequently, after 6 cycles of chemotherapy, maintenance Bevacizumab was started. In 2022, she presented with a first peritoneal and lymph node relapse, treated with secondary debulking (R0) and adjuvant chemotherapy (Carboplantin/Liposomal Doxorubicin), followed by maintenance Niraparib. In 2023, during follow-up, a slight increase in CA-125 (100 IU/mL) associated with subcentimetric retroperitoneal lymph nodes on CT scan were observed. The case was discussed in tumour board and it was decided to request PET-CT scan. The PET-CT showed lymph nodes at infrarenal interaortocaval and retrocaval levels suggestive of tumour relapase. Patient was scheduled for tertiary debulking surgery. After complete surgery (R0), anatomopathological study showed 6 lymph nodes with metastases of high-grade serous carcinoma. The case was discussed again in tumour board and adjuvant systemic treatment was decided with Carboplatin/Gemcitabine (Platinum TFI> 6 months).

Conclusion CA-125 determination is the simplest way to detect a potential relapse in patients under follow-up for ovarian cancer, which, together with physical examination and patient‘s symptoms, enables the selection of most appropiate imaging tests. Debulking surgery may provide benefit in secondary or subsequent recurrences, as long as complete cytoreduction is achieved. These cases should always be managed in specialised centres and by multidisciplinary teams.

Disclosures Authors declare no conflict of interest.