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1282 Lymph node recurrences in ovarian cancer: safe techniques in the minimally invasive approach
  1. Silvio Andrea Russo1,
  2. Camilla Certelli2,
  3. Aniello Foresta3,
  4. Andrea Rosati4,
  5. Alex Federico5,
  6. Luca Palmieri6,
  7. Giovanni Scambia7,
  8. Anna Fagotti8 and
  9. Valerio Gallotta2
  1. 1Policlinico Agostino Gemelli, IRCCS, Roma, Italy
  2. 2UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  3. 3Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  4. 4Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  5. 5Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  6. 6Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  7. 7Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  8. 8Dipartimento Scienze della Salute della Donna, del Bambino e di Sanita` Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy


Introduction/Background Lymph node recurrence accounts for 12% to 37% of ovarian cancer recurrent (ROC) patients. It is considered more indolent compared to parenchymal and peritoneal disease and, in selected cases, more suitable to take advantage of surgical rather than medical treatment. Previous studies have already proved the feasibility of minimally-invasive surgery (MIS) in the management of lymph-nodal recurrences with acceptable surgical outcomes, showing no differences in PFS according to extent of lymphadenectomy. We aim to describe the surgical steps for a safe removal of lymph node recurrences, focusing on the benefits of MIS.

Methodology This is a video article presenting two patients with platinum-sensitive lymph node recurrence of OC, one located at the inferior vena cava and the other between the common hepatic artery and the portal vein. Both surgeries were entirely conducted in MIS approach.

Results The MIS approach involves the following steps: (i) access to the operating field with better visualization of adhesions and more accurate adhesiolysis; (ii) Identification of the precise site of the recurrence and its relationship with surroundings structures. When needed, isolation of the vascular structures may allow greater control in case of complications; (iii) absence of manipulation of the lesion, keeping constant traction of healthy tissue avoiding spread of neoplastic material; (iv) safe removal of surgical pieces.

Conclusion The MIS approach can play a crucial role in the treatment of selected patients with lymph node recurrences, especially in specialized oncological centers since a high level of expertise and skills is required. Advantages of MIS compared to the open approaches include less blood loss, more accurate adhesiolysis, greater safety in dissecting anatomical planes, a more precise visualization of anatomical boundaries, a shorter hospital stay, which is also a factor influencing earlier postoperative recovery, and consequently the possibility of an adequate and maybe quicker onset of adjuvant chemotherapy.

Disclosures The authors declare no conflict of interest.

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