Addley Susan, Soleymani Majd Hooman
Oxford University Hospitals NHS Foundation Trust, Department of Gynae-Oncology, Churchill Hospital, Old Road, Headington OX3 7LE, United Kingdom.
Gynecol Oncol Rep. 2021 Feb 4;36:100709. doi: 10.1016/j.gore.2021.100709. eCollection 2021 May.
The findings of the DESKTOP 3 (Du Bois et al., 2017) study advocate secondary cytoreduction in patients with disease relapse of ovarian or peritoneal malignancy meeting specified criteria. We present a surgical video demonstrating the technique of laparoscopic resection of single site pelvic side wall recurrence 6 years after stage IIIc high grade serous primary peritoneal cancer. In 2014, our patient underwent 3 cycles of neo-adjuvant Cisplatin/Paclitaxel, followed by interval debulking surgery - achieving R0 - for stage IIIc high grade serous primary peritoneal carcinoma. Six years later, at aged 81 years, routine surveillance identified a rising CA 125 level of 91. CT imaging confirmed single site recurrence, reporting an isolated enlarged (3.5 × 2 cm) external iliac lymph node. Given the prolonged disease-free interval, absence of ascites, resectability of recurrent disease and fitness for surgery - secondary cytoreduction was undertaken. Our surgical video demonstrates gaining laparoscopic retroperitoneal access and the subsequent development of the lateral pelvic spaces to facilitate safe excision of disease relapse with a clear surgical margin, Our surgical video demonstrates the feasibility of minimal access surgery for single site recurrence of peritoneal carcinoma, highlighting the importance of understanding and exposing pelvic sidewall anatomy to enable safe and adequate resection - systematically identifying and preserving the ureter, iliac vessels and obturator nerve.
DESKTOP 3（Du Bois等人，2017年）研究结果主张，对于符合特定标准的卵巢或腹膜恶性肿瘤疾病复发患者，应进行二次细胞减灭术。我们展示一段手术视频，其演示了在IIIc期高级别浆液性原发性腹膜癌6年后，腹腔镜切除单部位盆腔侧壁复发灶的技术。2014年，我们的患者接受了3个周期的新辅助顺铂/紫杉醇治疗，随后进行了中间减瘤手术，对于IIIc期高级别浆液性原发性腹膜癌实现了R0切除。6年后，患者81岁时，常规监测发现CA 125水平升至91。CT成像证实为单部位复发，报告有一个孤立增大（3.5×2厘米）的髂外淋巴结。鉴于无病间期延长、无腹水、复发病灶可切除且适合手术，遂进行了二次细胞减灭术。我们的手术视频展示了获得腹腔镜腹膜后入路以及随后盆腔外侧间隙的拓展，以利于安全切除复发灶并获得清晰的手术切缘。我们的手术视频展示了针对腹膜癌单部位复发进行微创手术的可行性，强调了理解和暴露盆腔侧壁解剖结构以实现安全充分切除的重要性——系统识别并保留输尿管、髂血管和闭孔神经。
