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Lymph node recurrence accounts for 12%–37% of ovarian cancer relapses. It is considered more indolent compared with parenchymal and peritoneal disease and more suited to take advantage of surgical rather than medical treatment.1 According to recent clinical trials, surgery has been confirmed as a valid therapeutic strategy when there is a complete gross resection,2 and this option is even more valuable in patients with oligometastatic lymph node relapses. Previous studies have already proved the feasibility of minimally invasive surgery in the management of lymph node recurrences with acceptable surgical outcomes, with no differences in progression-free survival according to extent of lymphadenectomy.3 We aim to describe the surgical steps for the safe removal of lymph node recurrences, focusing on the benefits of laparoscopic surgery.
This Video 1 presents two patients with platinum-sensitive lymph node ovarian cancer recurrence located at the lumbo-aortic level. In the first case we describe a single recurrence at the precaval level, while in the second case multiple lymphadenopathies are removed at the retrocaval and para-aortic levels. All surgeries were entirely conducted using the minimally invasive approach. In planning the surgical treatment we performed pre-operative vascular assessment according to Tinelli’s score.4
Video still image capturing the moment when a lymph node recurrence is removed from the inferior vena cava, using loop vessels to isolate and secure the blood vessel.
Our approach involves the following steps: access to the operating field with better visualization of adhesions and more accurate adhesiolysis; identification of the precise site of the recurrence and its relationship with surrounding structures; when needed, isolation of blood vessels may allow greater control in case of complications; absence of manipulation of the lesion, keeping constant traction of healthy tissue avoiding spread of neoplastic material; and safe removal of surgical specimens in endobags.
The minimally invasive approach can play a crucial role in the treatment of selected patients with lymph node recurrences, especially in highly specialized oncological centers, since a high level of expertise and skills are required. Advantages of minimally invasive surgery compared with the open surgical approach 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 post-operative recovery, and consequently the possibility of an adequate onset of adjuvant chemotherapy.
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Data are available upon request.
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Footnotes
X @annafagottimd
Presented at This video article was presented at the 25th European Society of Gynaecological Oncology (ESGO) Congress held in Barcelona, Spain, March 7–10, 2024.
Contributors SAR: conceptualization, video editing, and writing original draft. SA: conceptualization, video speaker, and writing original draft. CC: conceptualization, project administration, supervision, and writing review. AR: conceptualization, project administration, supervision, and writing review. AFe: conceptualization, project administration, supervision, and writing review. AFa: conceptualization, project administration, supervision, and writing review. GS: conceptualization, project administration, supervision, and writing review. VG: conceptualization, guarantor, project administration, surgery and video recording, supervision, and writing review.
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.