Laparoscopic Excision of a 5-cm Retroaortic Relapse of Ovarian Cancer

Abstract

Objective: To demonstrate the feasibility of laparoscopic secondary cytoreduction of isolated lymph node relapse of ovarian carcinoma.

Design: A video explanation of a safe excision of ovarian cancer relapse using pictures to show the anatomic landmark of the retroperitoneum guiding the procedure.

Setting: Department of Obstetrics and Gynecology, Ospedale degli Infermi Hospital, Biella, Italy. The video was approved by the local institutional review board.

Interventions: A 61-year-old woman was referred to our center after the diagnosis of a 5-cm bilobate lumbo-aortic relapse of ovarian cancer, 15 months after comprehensive primary surgery, performed in another center by laparotomy and chemotherapy for a stage IIIA2 disease [1-4]. By laparoscopy, extensive adhesiolysis between the small bowel and abdominal wall was performed, showing a peritoneal cavity without any signs of carcinomatosis or disease spread. The laparoscopic operation continued with opening of the preaortic retroperitoneum and exposure of the major vessels, the psoas muscles, and the ureters. The disease relapses were identified as 2 confluent bulky nodal tissues on the left and posterior aspect of the aorta. Complete laparoscopic excision of the 2 masses was achieved. Postoperative course was uneventful, and the patient was discharged from the hospital 2 days after the surgery. Final pathological examination revealed that the 2 masses removed consisted of a total of 10 and 7 metastatic nodes, respectively. The patient initiated postoperative platinum-based chemotherapy 3 weeks after the surgery, and at present, 13 months after the operation, computed tomography scan is negative, and she is free of the disease.

Conclusion: Laparoscopic approach to isolated relapse of ovarian cancer is feasible and safe, with fast recovery.