External iliac artery ligation due to late postoperative rupture after radical lymphadenectomy for advanced ovarian cancer--two case reports.

According to the present guidelines for advanced epithelial ovarian cancer (EOC), bulky lymph nodes should be removed as part of the routine surgical staging and the primary goal being removal of all macroscopic tumor residuals. Furthermore, EOC-patients with bulky lymph node relapse seem to benefit from lymphadenectomy in terms of recurrence and overall survival.We present two cases of severe postoperative hemorrhage due to external iliac artery rupture ten and 12 days after radical bulky lymph node removal in primary and recurrent EOC-patients. Both cases were successfully managed by ligation of the two arms of the external iliac artery achieving immediate hemostasis. No crossover bypass was required to maintain lower extremity perfusion. Late rupture of the iliac vessels is a rare complication of systematic lymphadenectomy in EOC. This complication can be managed by unilateral external iliac artery ligation without mandatory subsequent graft interposition or crossover bypass.