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Relapse of ovarian cancer is a challenging situation that could be managed with systemic therapy or surgery.1 2 This situation requires the evaluation of many clinical aspects by a multidisciplinary team. A clinical trial confirmed that only complete resection was associated with any long-term benefit in recurrent ovarian cancer.3 In addition, a recent randomized trial showed that cytoreductive surgery followed by chemotherapy, resulted in longer overall survival than chemotherapy alone.4
When performing cytoreductive surgery, all tumoral lesion in the pelvis, upper abdomen, and retroperitoneum should be removed as far as possible. Resection of the upper abdominal lesions, including the lymph nodes in the hepatic hilar area, can significantly improve the prognosis of patients with advanced or relapsed ovarian cancer. However, the hepatic hilum area is complicated. This area is adjacent to important structures, such as the biliary system, the hepatic artery, the portal vein, and inferior vena cava, which increases the difficulty of the resection.2
This video shows how we performed the resection of an isolated ovarian cancer relapse located at the hepatic hilum (Figure 1). Our patient, was treated in 2021 for advanced-stage ovarian carcinoma and underwent complete primary cytoreduction. The patient received adjuvant treatment based on standard platinum-based chemotherapy. After the first year of follow-up, the patient was diagnosed with a single recurrence at the level of the hepatic hilum confirmed by PET-CT. Surgery was performed by general and gynecological oncological surgeons. After checking there were no other macroscopic tumors in the abdominal cavity we proceeded to the identification, dissection, and referencing of the main structures of the hepatic hilum (common hepatic artery, common bile duct and portal vein). This maneuver allowed complete removal of the tumor under safe conditions.
Tumorous relapse in the posterior aspect of the hepatic hilum.
Complete secondary cytoreduction surgery in relapsed ovarian cancer at hepatic hilum is feasible in selected patients.
Data availability statement
All data relevant to the study are included in the article.
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Footnotes
X @CFondevila
Presented at This work has previously been presented as an abstract at the 24th European Congress on Gynaecological Oncology, October 2023.
Contributors MG: conception and design, article drafting and revision, video editing and revision, approval of the final manuscript, guarantor. CF, AHG, IP, MAE: video revision and approval of the final manuscript. IZ: conception and design, article and video revision, approval of the final manuscript.
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.