Laparoscopic resection of single site pelvic side wall recurrence 6 years after stage IIIc high grade serous primary peritoneal cancer

Highlights

• •Feasibility of laparoscopy for optimal debulking of single site recurrence.
• •Importance of early retroperitoneal access and safe identification of anatomy.
• •Use of avascular pelvic spaces to facilitate dissection and preserve visibility.

Abstract

The findings of the DESKTOP 3 (Du Bois et al., 2017) ​study advocate secondary cytoreduction in patients with disease relapse of ovarian or peritoneal malignancy meeting specified criteria. We present a surgical video demonstrating the technique of laparoscopic resection of single site pelvic side wall recurrence 6 years after stage IIIc high grade serous primary peritoneal cancer.

In 2014, our patient underwent 3 cycles of neo-adjuvant Cisplatin/Paclitaxel, followed by interval debulking surgery – achieving R0 – for stage IIIc high grade serous primary peritoneal carcinoma. Six years later, at aged 81 years, routine surveillance identified a rising CA 125 level of 91. CT imaging confirmed single site recurrence, reporting an isolated enlarged (3.5 × 2 cm) external iliac lymph node. Given the prolonged disease-free interval, absence of ascites, resectability of recurrent disease and fitness for surgery – secondary cytoreduction was undertaken. Our surgical video demonstrates gaining laparoscopic retroperitoneal access and the subsequent development of the lateral pelvic spaces to facilitate safe excision of disease relapse with a clear surgical margin, Our surgical video demonstrates the feasibility of minimal access surgery for single site recurrence of peritoneal carcinoma, highlighting the importance of understanding and exposing pelvic sidewall anatomy to enable safe and adequate resection – systematically identifying and preserving the ureter, iliac vessels and obturator nerve.

Video 1.

Authors contribution

Both authors were directly involved in producing the work – Mr Soleymani majd being the operating surgeon and Dr Addley editing and narrating the surgical film – and both authors agreeing on the final submission.

CRediT authorship contribution statement

Susan Addley: . Hooman Soleymani Majd: Supervision.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.