Corona, A.
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- Combined transanal minimally invasive surgery (TAMIS) and retroperitoneal laparoscopy for resection of lymph node recurrence of ovarian cancer(2018) Pastor, E. (Enrique); Fuentes, S. (Silvia); Diago, M. V.; Corona, A.; Lorenzo, E.; Villafañe, A. (Amaya); Padilla, L.; Lelpo, B. (Benedetto); Arredondo, J. (Jorge); Simó, V. (Vicente); Orille, V.To our knowledge no cases of transanal minimally invasive surgery (TAMIS) combined with retroperitoneal laparoscopy for resection of lymph node recurrence have been described in the literature. We report a case of resection of mesorectal and para-aortic lymph node recurrence of primary ovarian cancer performed with retroperitoneal laparoscopy and TAMIS. A 66-year-old female, diagnosed in December 2014 with stage IIa ovarian adenocarcinoma had cytoreductive surgery at that time, achieving a R0 resection (complete hysterectomy with bilateral ovariectomy, pelvic peritonectomy with standard lymphadenectomy and supramesocolic omentectomy). Surgery was followed by adjuvant treatment. On November 2017, a computed tomography scan revealed lymph node recurrence in the left para-aortic nodes (2.5 cm diameter on CT) and mesorectal space (2.8 cm diameter) at 10 cm from the anal verge. After a multidisciplinary session, both nodes were resected (see attached video). The para-aortic node was resected using retroperitoneal laparoscopy and the mesorectal node resected using a TAMIS approach [1,2,3]. The postoperative course was uneventful and the patient was discharged 5 days after surgery. Histopathological examination of the two nodes revealed undifferentiated serosal adenocarcinoma of the ovary. No recurrence was found at 1-year follow-up. Combination of different minimally invasive approaches is a safe alternative to conventional surgery for resection of lymph node recurrence that surgeons should be aware of.