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Summary
Advanced or recurrent gynecologic cancers with retroperitoneal lymphatic disease may involve the inferior vena cava (IVC) and achieving radical debulking of the disease in this scenario is challenging.1 2 The concept ‘oncovascular surgery’ defines the case of tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to the great vessels.3
The aim of this video is to demonstrate the surgical procedures for radical en bloc resection of metastatic lymph nodes and the infiltrated IVC with simultaneous vascular reconstruction.
The indication for the debulking surgery was a first isolated recurrence of endometrioid endometrial cancer grade 2 (first diagnosis International Federation of Gynecology and Obstetrics (FIGO) stage IB followed by pelvic external beam radiotherapy) in a patient with good performance status. Bulky precaval lymph nodes with infiltration of the IVC were identified, while other distant metastases were excluded. The multidisciplinary tumor board approved surgery as a treatment option. The lymph node metastasis infiltrated the IVC with absence of a reliable dissection plane. After systemic heparin infusion and proximal and distal clamping of the vessel, we performed an en bloc resection of metastatic lymph nodes along with the infiltrated portion of the IVC. Subsequent vascular reconstruction was performed with a bovine patch. A running polypropylene suture (Prolene 5/0) was used to fix the patch in place (Figure 1). An intravascular heparin bolus was injected at the end of the procedure. Complete removal of macroscopic disease was achieved. No intra-operative or post-operative complications were observed.
Final field of the inferior vena cava after the vascular resection and reconstruction through a bovine patch.
Tumor debulking with en bloc vascular resection and subsequent reconstruction is a feasible procedure but requires accurate pre-operative planning and an experienced surgical team. Gynecologic oncologists need to be familiar with the concept of ‘oncovascular surgery’ in order to provide the best curative treatment even in the challenging case of advanced cancers with vascular involvement.4
Data availability statement
All data relevant to the study are included in the article.
Ethics statements
Patient consent for publication
Acknowledgments
The results of this study have been presented as an oral video presentation at the Video Session – Radical Surgery and Reconstruction at the 24th European Congress on Gynecological Oncology (ESGO), 28 September–1 October 2023, Istanbul, Turkey.
Footnotes
X @Cucinella_G
Contributors GC: manuscript preparation, data collection, patient recruitment, participant at surgery, video preparation. MCD: manuscript preparation, data collection, patient recruitment, participant at surgery, video preparation and narrative voice. GZ: manuscript preparation, data collection, patient recruitment and video preparation. CR: data analysis and interpretation. CS: manuscript preparation, video preparation. VC: conception of the video, data analysis and interpretation, patient recruitment, responsible surgeon and guarantor.
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.