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Introduction
In recurrent oligometastatic ovarian cancer, complete disease removal followed by chemotherapy improves overall survival.1 For oligometastatic disease involving the spleen, conventional laparoscopic splenectomy is the most cost-effective, minimally invasive method.2 We present a novel approach, pancreatic peritonectomy with splenectomy to achieve R0 cytoreduction in recurrent ovarian cancer. The pelvic peritonectomy is a well-described surgical technique applied to cancers that have spread to the pelvic peritoneum.3 The anterior pancreatic peritonectomy extends this method to cases of recurrent ovarian cancer closely associated with the pancreas. Complete disease removal is possible with pancreatic peritonectomy, given that the pancreas is secondarily retroperitonealized. This allows for separation of the peritoneum and disease from the anterior surface of the pancreas. This technique avoids a partial pancreatectomy and ensures proximal control of the splenic vessels when accessing the splenic hilum is challenging.4
Methods
A patient in her 60s presented with platinum-sensitive, oligometastatic, high-grade, serous ovarian cancer. Positron emission tomography (PET) scan showed a solitary lesion (2.5×3.0 cm, standardized uptake value (SUV) 15) in the splenic hilum extending to the pancreas. Key steps included pancreatic peritonectomy, proximal splenic vessel isolation, and mobilization of the pancreatic body and tail. The procedure was recorded using a 30° camera (supplemental materials).
Results
Splenectomy was completed without the need for a partial pancreatectomy. The procedure lasted 2 hours with 50 cc blood loss. The patient was discharged on Day 3 without complications. Platinum-based chemotherapy was administered following a 2 week recovery period.
Conclusions
This video demonstrates a novel approach in gynecologic cancer, utilizing laparoscopic pancreatic peritonectomy for tumor removal from the superior border of the pancreas. This approach facilitates complete cytoreduction and effective control of the proximal splenic vessels, while preserving the body and tail of the pancreas. Eliminating the need for a partial pancreatectomy avoids associated complications. This technique leverages established peritonectomy practices in gynecologic malignancies to offer faster recovery and reduced costs compared with open and robotic surgery.
Anatomy pertinent to a laparoscopic anterior pancreatic peritonectomy with splenectomy. The figure depicts the close proximity of the tumor to the splenic hilum and pancreas, and further illustrates the important vascular structures.
Supplemental material
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors CV, YA, NP, YEC, BM: worked on the abstract and video dictation. GA: developed the concept and oversaw the completion of the project. GA is the guarantor and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.
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 Not commissioned; externally peer reviewed.
Author note All data relevant to the study are included in the article or uploaded as supplementary information
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.