Robotic Secondary Cytoreductive Surgery: A Personalized Surgical Approach For a Triple-Site Ovarian Cancer Recurrence

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Abstract Background The role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer has increased in recent years. Randomized prospective trials have shown a survival advantage in cases of complete gross resection. 1,2 In this context, minimally invasive surgery has taken on a significant role, especially in cases of single and oligometastatic recurrence. 3–6 The aim of this video is to describe the feasibility of a robotic triple-site approach for SCS in recurrent ovarian cancer. Methods A case of oligometastatic platinum-sensitive ovarian cancer recurrence in a woman in her 40s is presented. Preoperative computed and emission tomography scans detected three sites of recurrence: a right cardiophrenic lymph node, a nodule at the hepatic hilum between the head of the pancreas and the hepatic artery, and interaortocaval lymphadenopathy below the left renal vein. After a preoperative 3D reconstruction, a robotic SCS was performed in three anatomical regions. Results Complete cytoreduction was achieved. The operation time was 200 min, and the estimated blood loss was 100 mL. The patient underwent extensive adhesiolysis because of previous surgery. No intraoperative complications occurred. The histological examination confirmed the metastatic involvement of the three lesions. Conclusions A robotic approach can be considered in selected patients with extrapelvic ovarian cancer recurrence, even in different anatomical sites, in oncological centers with a multidisciplinary team of expert surgeons. Patient selection and preoperative 3D reconstruction are very important elements in the surgical planning.

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