• Cervical Cancer
• Surgical Oncology
• Laparoscopes
• Neoplasm Recurrence, Local

Disease recurrence poses a clinical challenge for patients with cervical cancer, and the selection of optimal treatment depends on previous therapy and the site of the recurrent tumor.1 2 Para-aortic lymph nodes and the lungs are the extrapelvic areas most frequently affected, while adrenal gland involvement is rarely reported. Survival benefits of secondary radical surgery in localized recurrence have been claimed by several authors.3 4 However, this aspect has been poorly explored in the literature, with limited case series, primarily concentrating on lung metastases.5

We present the case of an isolated adrenal gland and retrocaval lymph node recurrence in a woman in her 60s affected by International Federation of Gynecology and Obstetrics stage IVB cervical cancer, previously treated with chemotherapy and pelvic radiotherapy. Preoperative computed and emission tomography scans detected a nodule of 26 mm with increased uptake involving the medial lip of the right adrenal gland and a lymph node of 8 mm posterior to the inferior vena cava. Given the oligometastatic recurrence, the unusual localization of the nodules, and after multidisciplinary discussion, the patient was counseled for a retrocaval lymphadenectomy and right adrenalectomy.

In this video, we show the minimally invasive approach tailored to the patient’s disease distribution (figure 1), assisted by intraoperative ultrasound. This technique proved highly valuable in identifying metastatic nodules and confirming complete removal of the disease.6 Complete gross resection was achieved within 240 min of operative time, with no reported intraoperative or postoperative complications. The final histology confirmed the metastatic involvement of both the adrenal gland and the retrocaval lymph node by an undifferentiated carcinoma.

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Figure 1

Separation of the vena cava from the adrenal gland, reaching the right crus of the diaphragm, and exposing the suprarenal arteries and the suprarenal vein.

The minimally invasive approach can be considered in selected patients with extrapelvic cervical cancer recurrence. Intraoperative ultrasound may be considered to guide the resection and tailor the surgery. Surgical removal enables molecular analysis, including PD-L1 expression, a predictive biomarker for response of immune checkpoint inhibitors and a potential prognostic signature.