Oliva Riccardo, Rosati Andrea, Certelli Camilla, Palmieri Luca, Giudice Maria Teresa, Scaglione Giulia, Marescaux Jacques, Scambia Giovanni, Fagotti Anna, Gallotta Valerio
Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
IRCAD, Research Institute against Digestive Cancer, Strasbourg, France.
Ann Surg Oncol. 2025 Jun;32(6):4324-4325. doi: 10.1245/s10434-025-17183-2. Epub 2025 Mar 18.
Isolated parenchymal splenic relapse is a rare condition experienced by patients presenting with recurrent ovarian cancer (ROC). In such cases, complete secondary cytoreductive surgery (SCS) followed by chemotherapy offers significant overall survival benefits for platinum-sensitive ROC patients. Randomized trials such as DESKTOP-3 and SOC-1 described splenectomy during SCS in 6-15% of patients. Robotic-assisted surgery (RAS) and advanced three-dimensional (3D) imaging reconstruction can be integrated when choosing minimally invasive surgery (MIS) to reduce the risks associated with splenic procedures. METHODOLOGY: The case of a 70-year-old BRCA2-mutated patient with single-site splenic ROC is presented. Computed tomography (CT) scan was reviewed by an expert radiologist during a multidisciplinary tumor board. The images were manually segmented using 3D Slicer software to obtain the final 3D reconstruction. Using the da Vinci Xi™ robot (Intuitive Surgical, Sunnyvale, CA, USA), a medial-to-lateral spleen dissection was performed. Several key surgical steps were followed to avoid tumor manipulation and subsequently minimize potential neoplastic spread.
Intraoperative ultrasound confirmed lesion localization, and advanced robotic instruments facilitated precise hilum control, reducing the risk of bleeding and pancreatic tail injury. Robotic SCS with complete tumor resection was achieved. No intraoperative or postoperative complications were reported. Final histology confirmed the diagnosis of high-grade ROC.
RAS represents a viable option for SCS in ROC patients with isolated parenchymal localization. The integration of 3D reconstruction with RAS allows for a tailored approach in complex cases. A high-level of expertise and appropriate identification of candidates for MIS-SCS are required to achieve the best outcomes for ROC patients.
孤立性脾实质复发是复发性卵巢癌（ROC）患者中罕见的情况。在此类病例中，对于铂敏感的ROC患者，完整的二次细胞减灭术（SCS）后进行化疗可带来显著的总生存获益。诸如DESKTOP - 3和SOC - 1等随机试验描述了在SCS期间6% - 15%的患者进行了脾切除术。在选择微创手术（MIS）时可整合机器人辅助手术（RAS）和先进的三维（3D）成像重建，以降低与脾脏手术相关的风险。
介绍了一名70岁的BRCA2突变的单部位脾ROC患者的病例。在多学科肿瘤委员会会议期间，由专业放射科医生对计算机断层扫描（CT）图像进行了评估。使用3D Slicer软件对图像进行手动分割以获得最终的3D重建。使用da Vinci Xi™机器人（美国加利福尼亚州森尼韦尔市直观外科公司）进行了从内侧到外侧的脾脏剥离。遵循了几个关键的手术步骤以避免肿瘤操作，从而尽量减少潜在的肿瘤播散。
术中超声确认了病变定位，先进的机器人器械有助于精确控制脾门，降低了出血和胰尾损伤的风险。实现了机器人辅助的SCS并完整切除了肿瘤。未报告术中或术后并发症。最终组织学确诊为高级别ROC。
对于孤立性脾实质定位的ROC患者，RAS是SCS的一种可行选择。3D重建与RAS的整合可为复杂病例提供定制化方法。为使ROC患者获得最佳治疗效果，需要高水平的专业技能以及对MIS - SCS候选者进行恰当识别。
