Secondary debulking surgery for isolated para-aortic nodal recurrence in ovarian cancer involving the division of the left renal vein

Suprarenal lymphadenectomy with nephrectomy for refractory ovarian cancer

The effect of debulking surgery is not vague in patients with refractory ovarian cancer because of drug-resistant tumor biology showing rapid growth. However, it can be considered to be beneficial for selected patients expected to show tumor response by postoperative treatment because the better perfused small tumors may favor the action of cytotoxic therapy. Among them, patients with enlarged lymph nodes and BRCA mutations can show a relatively high rate of response and improved survival by systematic lymphadenectomy followed by poly ADP ribose polymerase (PARP) inhibitors. However, the resection of enlarged lymph nodes above the renal vein may not be familiar to gynecologic oncologists, in particular, for patients who had undergone previous debulking surgery followed by repetitive chemotherapy. Thus, this video will show the step by step procedure of suprarenal lymphadenectomy and en bloc resection of kidney and suprahilar lymph nodes for complete resection of refractory ovarian cancer.

Secondary debulking surgery for isolated para-aortic nodal recurrence in endometrial cancer requiring partial resection of the inferior vena cava

OBJECTIVE

We report the details of a surgical technique for the cytoreduction of metastatic para-aortic lymph nodes with involvement of the inferior vena cava (IVC) requiring partial resection and repair of the IVC.

METHODS

A 52-year-old woman presented with endometrial cancer and isolated nodal recurrence involving the IVC. A vascular clamp was applied to the segment of the IVC that the metastatic lymph nodes had involved, and an en bloc resection of the para-aortic lymph nodes with the involved segment of the IVC was performed.

RESULTS AND CONCLUSION

In this case, a partial resection of the IVC was performed to enable a complete cytoreduction without encroaching on the tumor planes. No intraoperative or postoperative complications, including vascular complications, occurred. This surgical procedure can be adopted for the management of metastatic para-aortic lymph nodes in selected patients.