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Minimally invasive secondary cytoreductive surgery for hepato-renal recess isolated recurrence of serous endometrial cancer in BRCA1 mutated patient
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  1. Valentina Iacobelli1,
  2. Francesco Taliente2,
  3. Giovanni Scambia3,
  4. Francesco Fanfani4,
  5. Felice Giuliante5,6 and
  6. Valerio Gallotta7
  1. 1Department of Women and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
  2. 2Department of Hepatobilary Surgery, Catholic University of the Sacred Heart, Rome, Italy
  3. 3Department of Women's and Children's Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  4. 4Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
  5. 5Department of Hepatobilary Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  6. 6Catholic University of the Sacred Heart, Rome, Italy
  7. 7Department of Women's and Children's Health, Policlinico A Gemelli, Rome, Italy
  1. Correspondence to Dr Valentina Iacobelli, University Hospital Agostino Gemelli, Roma, rm, Italy; vale.iacobelli{at}gmail.com

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Serous endometrial cancer represents a relatively rare entity, accounting for about 10% of all diagnosed endometrial cancer, but it is responsible for 40% of endometrial cancer-related deaths. Patients with serous endometrial cancer have a higher risk of recurrence and poorer prognosis when compared stage-for-stage with endometrioid endometrial cancer. Serous endometrial cancer shows an aggressive behavior and shares most of its molecular features with high-grade serous ovarian cancer, such as the occurrence of BRCA mutations, whose role in this setting is still not completely understood. 1 2 Moreover, the role of secondary cytoreductive surgery for recurrent disease has not been standardized.3 4

This video shows the surgical management of a young BRCA1-mutated woman affected by a recurrence of serous endometrial cancer. The aim of this film is to show how a minimally invasive surgical approach is safe and feasible in selected patients.

We present the case of a hepato-renal recess isolated recurrence of serous endometrial cancer. Patient positioning and port placement were critical to achieve an optimal exposure of the liver sixth segment and the Morison’s pouch. An extensive adhesiolysis was performed and the metastasis was then exposed. The tumor infiltrated the liver parenchyma for <2 cm, thus a superficial wedge resection was executed. The procedure was performed in 90 min. The post-operative course was unremarkable; the patient was discharged on post-operative day 3 and she resumed her oral poly ADP ribose polymerase (PARP) inhibitor after 15 days. The histopathology report confirmed the localization of a high-grade serous cancer.

Figure 1

Still image of the video showing and pointing out the anatomical structures involved in the surgery: laparoscopic access to the hepato-renal recess.

Minimally invasive surgery for recurrent endometrial cancer is achievable and beneficial in selected patients. Indeed, potential benefits include reduced blood loss, less pain, faster recovery, and a short interval to adjuvant chemotherapy. The personalized treatment of recurrent endometrial serous cancer should be guided by the molecular pattern of the disease and by the surgical skills with a multidisciplinary approach.

Video 1

Data availability statement

All data relevant to the study are included in the article.

Ethics statements

Patient consent for publication

Ethics approval

This study involves human participants and was approved by Protocol number DIPUSVSP-PD-03-2211. Participants gave informed consent to participate in the study before taking part.

References

Footnotes

  • Twitter @frafanfani

  • Contributors VG, FG and FF contributed to the design and the surgical part of the study, VI and FT created the video. GS contributed as a guarantor. All authors provided critical feedback and helped shape the video and the manuscript.

  • 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 Commissioned; externally peer reviewed.

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