Abstract
Background:
The surgical management of ovarian cancer is performed conventionally by laparotomy. The role of minimally invasive surgery has been highlighted in early stage disease, assessment of resectability and second-look surgery. However, laparoscopy in cytoreductive surgery for advanced ovarian cancer has not been established. The aim of this report is to demonstrate the role of the minimally invasive approach to primary cytoreductive surgical treatment of advanced ovarian cancer.
Case:
A 38-year-old multiparous woman presented with a gradually enlarging abdominal mass. A preoperative work-up showed that she actually had bilateral ovarian masses with extensive peritoneal carcinomatosis. The patient underwent laparoscopic cytoreductive surgery (hysterectomy, bilateral salpingo-oophorectomy, peritoneal fluid cytology, anterior and posterior pelvic peritonectomy, bilateral pelvic node dissection, low anterior resection with colo–anal reanastomosis, partial hepatectomy, right subdiaphragmatic peritonectomy, and ablation of liver and subdiaphragmatic peritoneal nodules) performed by a multidisciplinary team of gynecologic oncologists, as well as colorectal and hepatobiliary surgeons.
Results:
This patient's estimated blood loss was 350 mL. There were no intraoperative or postoperative complications. The histopathology result showed high-grade serous carcinoma of the bilateral ovaries with metastasis to the omentum, subdiaphragmatic peritoneum, and liver capsule. The final surgicopathologic stage was IIIC. The patient received her first course of adjuvant chemotherapy 11 days postsurgery with no adverse events and was discharged in an improved condition.
Conclusions:
Minimally invasive cytoreductive surgery for advanced ovarian cancer is a safe and feasible procedure. Laparoscopy enables better visualization of tumor involvement, ensuring complete removal of all visible disease. It allows for faster recovery, leading to a shorter interval to chemotherapy initiation.
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