Laparoscopic High Anterior Resection for Management of Primary Peritoneal Carcinoma Recurrence: A Case Report

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<h3>Study Objective</h3> For platinum-sensitive recurrent epithelial ovarian, primary peritoneal and fallopian-tube cancer, only complete resection of disease may confers a survival benefit of secondary debulking surgery (SDS). We will report a case who underwent laparoscopic high anterior resection (HAR) for management of localized recurrent primary peritoneal carcinoma (PPC). <h3>Design</h3> N/A. <h3>Setting</h3> Urban general hospital in Japan. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> A 70-year-old women with a history of FIGO stage ⅢC PPC presented with an intra-pelvic 3cm mass involving the rectosigmoid colon and vaginal stump by MRI 3 years after the completion of treatment. PET/CT revealed a single site recurrence and the patient desired laparoscopic resection of the recurrent lesion instead of chemotherapy alone. With the patient in the Lloyd-Davies position, 4 port trocars were placed for a modified diamond configuration. The tumor was located between the vaginal stump and the rectosigmoid colon. The right ureter was identified running just to the right of the mass. By right parametrial dissection, the right ureter was mobilized laterally, and the tumor was dissected from the vaginal stump by colpotomy. Posterolateral recto-sigmoid dissection was extended following the mesorectal plane and the rectosigmoid colon was divided by a flexible linear stapler distal to the tumor. By extending the left lower quadrant 5mm port to 4cm, the rectosigmoid colon was delivered. The tumor-free upper rectum was divided, and an anvil was inserted into the end of the bowel extracorporeally. Laparoscopic end-to-end anastomosis was made by a circular stapler inserted into the anus. Postoperative course was uneventful, and histopathology confirmed the recurrence of PPC with involvement in the rectosigmoid submucosa. <h3>Measurements and Main Results</h3> N/A <h3>Conclusion</h3> We demonstrated the feasibility of minimal invasive SDS for localized recurrence of PPC with colorectal invasion. Minimally invasive debulking should be considered appropriate for patients when managing locoregional recurrence of PPC.