Eradication of isolated para-aortic nodal recurrence in a patient with an advanced high grade sorous ovarian carcinoma: our experience and review of literature
Abstract: We report a case report regarding the eradication of isolated lymph-nodal para-aortic recurrence
in the aortic region down the left renal vein (LRV) in a patient treated two years earlier in
another hospital for a FIGO stage IC2 high-grade serous ovarian carcinoma with a video showing
the para-aortic space after eradication of the metastatic tissue. A 66 year-old woman was admitted
24 months after the initial surgical procedure for an increased Ca 125 level and CT scan that revealed
a 3 cm para-aortic infrarenal lymph-nodal recurrence that was confirmed by PET/CT scan. A secondary
cytoreductive surgery (SCS) with a para-aortic lymph-nodal dissection of the tissue down
the LRV and radical omentectomy were performed: during the cytoreduction, the right hemicolon
was mobilized. The anterior surface of the inferior vena cava (IVC), aorta and LRV were exposed.
The metastatic lymph nodes were detected in the para-ortic space down the proximal part of the
LRV and eradicated; an en bloc infrarenal lymph-node dissection from the aortocaval region was
performed. The operative time during the surgical procedure was 212 min with a blood loss of 120
mL. No intra- and postoperative complications, including ureteral or vascular injury or renal dysfunction,
occurred. At histological examination, three dissected lymph nodes were positive for metastasis,
and the patient was discharged five days after laparotomy without side effects and underwent
chemotherapy 3 weeks later; after a follow-up of 42 months, no recurrence was detected. In
conclusion, secondary debulking surgery can be considered a safe and effective therapeutic option
for the management of recurrences, although long-term follow-ups are necessary to evaluate the
overall oncologic outcomes of this procedure