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Laparoscopic splenectomy for secondary cytoreduction of ovarian cancer in a woman with localized splenic recurrence

Published:January 16, 2020DOI:https://doi.org/10.1016/j.ygyno.2019.12.021

      Highlights

      • Laparoscopic splenectomy is feasible and safe to perform for isolated ovarian cancer recurrence.
      • Patient positioning, trocar placement, and knowledge of LUQ anatomy are key in performing a laparoscopic splenectomy.
      • The splenectomy surgical approach is largely dictated by tumor location and size.
      • The surgical technique for laparoscopic splenectomy is similar to that for open splenectomy.

      Abstract

      Objective/background

      Laparoscopic splenectomy is a potential surgical option for the treatment of isolated gynecologic cancer recurrence to the spleen [
      • Ramirez P.T.
      • Dos Reis R.
      Splenectomy in patients with advanced or recurrent ovarian cancer: open and laparoscopic surgical techniques and clinical outcomes.
      ,
      • Katkhouda N.
      Splenectomy (total and partial) and Splenopancreatectomy.
      ,
      • Almond B.A.
      • Diehl K.M.
      Splenectomy.
      ,
      • Demetriades D.
      • Tadlock M.D.
      Splenic injuries.
      ,
      • Jankulovski N.
      • Antovic S.
      • Mitevski A.
      Splenectomy for haematological disorders.
      ,
      • Jankulovski N.
      • Antovic S.
      • Mitevski A.
      Splenectomy for haematological disorders.
      ,
      • Coleman
      • et al.
      Secondary surgical cytoreduction for recurrent ovarian cancer.
      ,
      • Ramirez P.T.
      Interval cytoreduction for advanced ovarian cancer: is minimally invasive surgery ready for the next prospective randomized trial?.
      ]. The purpose of this video is to demonstrate a step-by-step approach for laparoscopic splenectomy in the setting of recurrent, oligometastatic ovarian cancer.

      Methods

      We present the case of a 47-year-old female with recurrent, platinum-sensitive high-grade serous ovarian cancer. A computer tomographic scan demonstrated an isolated 1.5 × 1.0 cm recurrence in the splenic hilum. A laparoscopic secondary cytoreduction with splenectomy was planned. The surgical procedure was recorded via the video camera tower, and the key steps for a laparoscopic splenectomy were identified and highlighted.

      Results

      The indications for secondary cytoreductive surgery, the appropriate candidates for minimally invasive surgery, patient positioning principles to set the surgeon up for success, and left upper quadrant anatomy are reviewed. In the surgical case and in the setting of hilar disease, the technique and rationale for ligating the major splenic ligaments in a particular order are reviewed. The procedure for isolating and ligating the dominant vascular structures – the splenic artery and vein – are reviewed. Finally, perioperative and oncologic outcomes, including an estimated blood loss of 100 cc, operative time of 3 h, a disease-free interval and “no evidence of disease” status after chemotherapy at 14 months, are emphasized.

      Conclusions

      In this video, both anatomical references and the surgical technique for a laparoscopic splenectomy in the setting of recurrent ovarian cancer are illustrated. We demonstrate that laparoscopic splenectomy is feasible and safe with proper patient selection and positioning as well as meticulous surgical technique.
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        Splenectomy in patients with advanced or recurrent ovarian cancer: open and laparoscopic surgical techniques and clinical outcomes.
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        Secondary surgical cytoreduction for recurrent ovarian cancer.
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        Interval cytoreduction for advanced ovarian cancer: is minimally invasive surgery ready for the next prospective randomized trial?.
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