Article Text

Conventional laparoscopic resection of platinum-sensitive recurrent oligometastatic ovarian cancer lesion in the interaortocaval region
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  1. Yasmin Abozenah1,
  2. Christina Vlamis1,
  3. Maddie Ghazarian1,
  4. Justin Harold2,
  5. Joan Tymon-Rosario3 and
  6. Gary Altwerger1
    1. 1Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Yale School of Medicine, New Haven, Connecticut, USA
    2. 2Department of Obstetric and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
    3. 3Department of Gynecologic Oncology, Northwell Health Physician Partners, New Hyde Park, New York, USA
    1. Correspondence to Dr Gary Altwerger, Department of Gynecologic Oncology, Yale University, New Haven, Connecticut, USA; gary.altwerger{at}yale.edu

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    A patient in her 60s had previously undergone cytoreductive surgery followed by adjuvant chemotherapy for stage IIIB high-grade serous carcinoma of the fallopian tube. Somatic testing revealed loss of heterozygosity >16% (determined by Foundation Medicine), therefore the patient was placed on maintenance PARPi (poly-(ADP-ribose)-polymerase-1 inhibitor). One year after starting PARPi, the patient had a recurrence. A CT scan revealed peritoneal nodules and a 33.8 mm interaortocaval mass with absent ascites. We opted for laparoscopic resection due to the patient’s extensive co-morbidities and the CT scan showing oligometastatic peritoneal spread. Additionally, previous studies have shown adequate laparoscopic treatment of ovarian cancer.1 2 The patient underwent exploratory laparoscopy with evaluation of the bowel from the ileocecal valve to the ligament of Treitz, mobilization of the duodenum, removal of both the peritoneal nodules and the interaortocaval mass.

    On laparoscopic exploration, a suspicious peritoneal nodule was excised and was negative for cancer. During evaluation of the bowel, two mesenteric nodules were fully excised and returned positive. No further metastatic disease was identified within the peritoneum, and the decision was made to proceed with laparoscopic resection of the interaortocaval mass (Figure 1). Following a 2-week recovery, a second regimen of carboplatin/paclitaxel with bevacizumab was administered. After six cycles, PARPi maintenance was restarted. The patient has been disease-free for 2 years.

    Figure 1

    View of the adherent interaortocaval mass, the lesion is seen to the right of the aorta and just inferior to the duodenum.

    We performed conventional laparoscopy to remove residual disease owing to the patient’s medical co-morbidities. The laparoscopic approach expedited recovery, allowing for shorter time to chemotherapy and PARPi maintenance post-operatively. Future considerations may include direct administration of PARPi maintenance without additional chemotherapy as defined by Gauduchon et al.3 Conventional laparoscopy can be indicated in a select group of patients. Gynecologic oncologists' expertise in complex conventional laparoscopy is essential for delivering advanced, minimally invasive care in the absence of robotic surgery. Additionally, choosing conventional laparoscopy in place of robotic techniques can reduce healthcare expenses.4

    Supplemental material

    Video 1 Conventional laparoscopy for removal of a platinum-sensitive recurrent ovarian cancer lesion in the interaortocaval region.

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    Footnotes

    • Contributors YA, CV, MG, JH, JT-R and GA contributed to the abstract, and video dictation, and edited the video. In addition, GA developed the concept for this article. GA is responsible for the overall content as the guarantor. GA 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.

    • 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.