Laparoscopic surgery for isolated inguinal node relapse of high grade serous ovarian cancer using a bipolar combination instrument.

OBJECTIVE

To demonstrate step-by-step minimally invasive surgical technique for dissection of isolated inguinal node relapse of high grade serous ovarian cancer.

METHODS

A 54-year-old woman, BRCA1 +, underwent to open abdominal total hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and aortic lymphadenectomy with zero residual disease, for high grade serous ovarian carcinoma FIGO stage IIB. After surgery, patient underwent platinum-based chemotherapy for six cycles and follow-up examinations every 3 months for the first year and biannual for the second one. Abdominal TC-PET scan after 18 months revealed a right distal iliac external/inguinal nodal relapse (SUV max 18,4). Ca125 was 9,1 mUI/ml. Right pelvic peritoneum was opened (step 1) and right retroperitoneal spaces were developed. Ureter was medialized (step 2) and obturator fossa was developed (step 3). Access to the deep inguinal ring (step 4) allows to identify inguinal lymph node relapse caudally to deep iliac circumflex artery. Bulky node was isolated (step 5) and excised en-block with obturator nodes (step 6). The entire procedure was performed using only a bipolar combination instrument for laparoscopy. Operating time was about 120 minutes and estimated blood loss was <100 ml.

RESULTS

Pathology confirmed relapse of high grade serous ovarian cancer (CK7+; WT1+). Patient was discharged in post-operative day 3 without complications.

CONCLUSION

Minimally invasive surgery for excision of isolated inguinal node relapse of ovarian cancer is a feasible and effective technique.