Cytoreduction of para-aortic lymph nodes behind the inferior vena cava and the right renal vessels in a patient with fallopian tube cancer

Abstract

Objective. The resection of bulky lymph nodes is occasionally required to achieve a complete cytoreductive surgery for ovarian cancer. The most common area in which bulky nodes are encountered is at the level of the renal veins [1]. The authors present a cytoreduction technique for bulkypara-aortic lymph nodes locatedbehindthe inferior vena cava (IVC) and the right renal vessels that involves the mobilization of the right kidney. Methods. A 68-year-old woman underwent a laparotomy for FIGO stage IIIC (pT2c N1 M0) fallopian tube cancer with up-front cytoreductive surgery. Para-aortic adenopathy behind the right renal vessels and right pelvic adenopathy was preoperatively demonstrated on an enhanced computed tomography examination. After performing a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic lymphadenectomy, cytoreduction of the para-aortic lymph nodes behind the inferior vena cava and the right renal vessels was performed as follows: first, an incision was made along the peritoneal reflection in the right lumbar gutter. The right